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MSK 3.22.13
| Question | Answer |
|---|---|
| What inflammation labs are seen in RA? | elevated ESR, elevated c reactive protein |
| What immunologic labs are seen in RA? | positive RF, positive anti-CCP Ab, hypergammaglobulinemia |
| What hematologic labs are seen in RA? | anemia, thrombocytopenia, leukocytosis |
| What is rheumatoid factor? | IgM or IgA that binds to IgG |
| What are some non RA causes of a positive RF titer? | chronic infection, acute infection, sarcoid, chronic liver disease, malignancy (MM, Waldenstroms), normal aging |
| What are anti cyclic citrulinated peptide (anti ccp) ab? | present before onset of disease, > specificity than RF for RA |
| Where are erosions most commonly seen in RA? | PIP, MCP, ulnar styloid, MTP |
| What are the key dx criteria for RA? | morning stiffness, artrits in > 3 joints, symmetric arthritis, rheumatoid nodules, serum rheumatoid factor, radiographic changes |
| What happens to T cells in RA? | incr in RA synovium, self reactive T cells, abundant costimulatory molecules |
| Whathappens to B cells in RA? | make RF, anti ccp Ab, can form immune complexes |
| What are the most important cytokines in RA? | TNF alpha, IL-1, IL-6 |
| What are some major carviovascular risks in RA? | incr risk of MI, cardiac death |
| Do NSAIDs retard the progression of RA? | no |
| What is the mech of methotrexate in RA? | inhibits dihydrofolate reductase, retards development of erosison |
| What are the major SE of methotrexate? | liver, BM, pulmonary toxicity (dry cough, SOB) |
| What is the mech of etanercept, infliximab, adalimumab, certolizumab, golimumab? | anti TNF |
| What is the mech of rituximab? | anti CD 20 on B cells |
| What is the mech of anakinra? | IL-1 receptor antagonist |
| What is the mech of abatacept? | CTLA4 Ig which loinks it to IgG, decreses B cell and T cell stimulation |
| What are the major SE of infliximab? | anti TNF agen so concerned for Tb, histoplasmosis, maybe malignancy |
| What are the major SE of rituximab? | Anti-CD20 mab. can cause infusion reaction and infection (PML is of most concern) |
| What imaging should always be done in RA before surgery? | get a XR of cervical spine as RA pt can have asx instability of the neck, manipulation under anasthesia can cause SC injury |
| What is required for the Dx of JIA? | onset before 16, persistent artritis is present, other conditions rulled out |
| What is seen in systemic arthritis JIA? | quotidian fever >2 weeks, typical rash, hepato or splenomegaly, lymphadenopathy, serositis. possibly some anemia, leukocytosis, thrombocytosis, elevated ESR, CRP |
| What is a useful prognostic lab for JIA polyarthritis? | positive RF confers a poor prognosis |
| What is seen in oligoarticular JIA? | 4 or fewer joints, most commonly knee, ankle, elbow |
| What can JIA cause in the eye? | uveitis |
| In what JIA might NSAIDs be used alone? | oligo JIA |
| What are some key SE of corticosteroid use in kids? | cataracts, tendon rupture, obesity, diabetes, delay of puberty, osteoporiosis |
| Why is a uric acid > 7.5 significan? | because the solubility of urate is 7 mg/dL at 37 C. so above this crystals will precipitate |
| What is seen in classic acute gout? | red, hot, equisitely painful oligoartritis. induction by EtOH, surgery, diuretics, low dose aspirin, trauma. see podagra of great MTP joint |
| What is seen in chronic tohpaceous gout? | polyartropathy, see tophi in fingers, toes, olecranon bursa, ears |
| What are needle shaped positively birefringent crystals? | uric acid crystals |
| How is acute gout Tx? | NSAids, colchicine, steroid. NOT allopurinol or probenicid |
| What is the mech of allopurinol, febuxostate, pegylated uricase? | reduce uric acid production. inhbit xanthine oxidase except uricase which breaks down uric acid |
| What is the mech of probenicid? | incr uric acid excretion |
| What is the mech and SE of cochicine? | inhibits microtubules, can cause diarrhea and bone marrow surpression |
| What 2 drugs levels would incr if they are given allopurino or febuxostate? | these drugs inhibit xanthine oxidase which normally breaks down azothiprine and mercaptopurine. so allopurinol or febuxostate could cause toxic levels of thewse drugs |
| A rhomboid, weakly negatively birefringent crystal is indicative of? | pseudogout calciumpyrophospjhte crystals, these are calcium so xanthine oxidase inhibitors are not useful |
| What area is fairly unique to OA vs RA? | lumbar spine, OA does not have MCP joints, but OA does have thumb which RA doesnt |
| ` |
Created by:
tjs2123