Hosam Mohamed-
small joints; hand, wrist, feet
Which joints are usually involved in RA? (3)
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subluxation, joint instability, deformity, atrophy
What are the signs of late-stage RA? (4)
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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?
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hallux valgus(lateral deviation of the digit), bunions, callus
What deformities can occur at the big toe? (3)
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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 =
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splenomegaly, neutropenia/thrombocytopenia, more prone to infections
What are the symptoms of Felty Syndrome? (3)
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pancreas, kidney, lymph nodes, spleen, ocular, lungs, heart, vasculature
Which extra-articular involvements are associated with RA? (8)
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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)
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>=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)
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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)
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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
