small joints; hand, wrist, feet
Which joints are usually involved in RA? (3)
subluxation, joint instability, deformity, atrophy
What are the signs of late-stage RA? (4)
Baker's cyst
- located behind the knee resulting in the formation of a cyst caused by synovitis
subluxation of the metatarsal heads
How do hammer toe deformities occur?
hallux valgus(lateral deviation of the digit), bunions, callus
What deformities can occur at the big toe? (3)
rare; C1 and C2
Lumbar involvement is usually ______, but is typically in _________.
Small-vessel vasculitis
-infarcts near the ends of the fingers & toes; especially around the nail beds
invasion of blood vessel walls by inflammatory cells resulting in the obliteration of the vessel; producing infarct of the tissue distal to the area of involvement
What is vasculitis? (2)
Keratoconjunctivitis sicca
-atrophy of the lacrimal duct results in decreased tear formation
Sjogren syndrome
Keratoconjunctivitis Sicca + RA =
splenomegaly, neutropenia/thrombocytopenia, more prone to infections
What are the symptoms of Felty Syndrome? (3)
pancreas, kidney, lymph nodes, spleen, ocular, lungs, heart, vasculature
Which extra-articular involvements are associated with RA? (8)
joint pain/stiffness/swelling > 6 weeks, 3-4 joints affected, symmetrical symptoms, rheumatoid nodules developing under skin
What are the initial symptoms of RA? (4)
RF, ACPA, ESR, CRP
Which labs are examined in RA? (4)
b
Which is found in the majority of patients?
a) anticitrullinated protein antibody (ACPA)
b) rheumatoid factor
c) CRP
d) ESR
c,d
Which are non-specific measures of inflammation?
a) anticitrullinated protein antibody (ACPA)
b) rheumatoid factor
c) CRP
d) ESR
a
Which can exist before patients exhibit symptoms?
a) anticitrullinated protein antibody (ACPA)
b) rheumatoid factor
c) CRP
d) ESR
a
Which is a strong indicator of RA?
a) anticitrullinated protein antibody (ACPA)
b) rheumatoid factor
c) CRP
d) ESR
joint involvement, serology, duration of synovitis, acute phase reactants
What is the 2010 ACR/EULAR classification of RA based on? (4)
>=6
What score in the 2010 ACR/EULAR classification of RA indicates definite RA?
systemic
Which juvenile RA is characterized by a fever?
psoriatic, reactive, ankylosing spondylitis, arthritis associated w/ IB disease
What are the seronegative inflammatory arthritic conditions? (4)
rest, occupational/physical therapy, assistive devices, weight reduction, surgery
What are non-pharmacologic treatment options for RA? (5)
analgesic, anti-inflammatory, reduce stiffness
What are the main uses of NSAIDs in RA? (3)
pain relief/treatment of synovitis; bridge therapy while DMARDs are taking effect
What are the main uses of Corticosteroids in RA? (2)
when only a few joints are involved
When are intra-articular injections useful?
can be repeated every 3 months; can't inject one joint more than 2-3x per year
What are the dosing guidelines regarding intra-articular injections? (2)
monotherapy with non-MTX; combination with 2 or more DMARDs
What are the treatment options for patients who failed methotrexate? (2)
MTX + other DMARD; triple DMARD combination
What are the treatments for patients with moderate-high disease activity? (2)
when patients fail DMARD therapy; can be monotherapy or used in combination
When are biologic agents used in RA?
prevention of the development of ABs that reduce infliximab drug efficacy or allergic reactions
What is the use of Infliximab + MTX?
morning stiffness <15 min, no: fatigue, joint pain, tenderness/pain on motion, soft tissue swelling/tendon sheaths, ESR < 30mm/hr(female); <20 mm/hr (male)
ACR classification Criteria for Remission? (6)
a
Completely able to perform usual activities of daily living; vocational/avocational.
a) class I
b) class II
c) class III
d) class IV
b
Able to perform usual self-care/vocational activities, but limited in avocational activities.
a) class I
b) class II
c) class III
d) class IV
c
Able to perform usual self-care activities, but limited in vocational/avocational activities.
a) class I
b) class II
c) class III
d) class IV
d
Limited ability to perform usual self-care, vocational, and avocational activities.
a) class I
b) class II
c) class III
d) class IV