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CM- Rheum -1- RA

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Question
Answer
What is the peak onset for R.A.   age 25-45  
Who suffers more from R.A. M or F   F>M 3:1  
When is a women likely to experience relief from R.A.   improves during pregnancy and flares 4-6 weeks post partum  
What effect does R.A. have on mortality rates in general   Pts with rheumatoid arthritis have higher mortality than Gen'l population  
What are the classification criteria for R.A.   at least 4 of the following for >6wks; morning stiffness lasting >1hour, swelling in 3 or more joint areas, swelling in hand joints, symmetric joint swelling, rheumatoid nodules, rheumatoid factor, erosions or osteopenia on hand x-ray  
What is the pathophysiology of R.A. I.e. what is the underlying cause   swollen inflamed synovial membrane  
What is the pathognomonic cellular finding for R.A.   Pannus (hypertrophic Synovium)  
What is the problem with pannus (hypertrophic Synovium)   normally synovium doesn't cover cartilage in R.A. you get invasion of synovium into the cartilage, tendons and ligaments  
What joints are classically involved in R.A.   MCPs, PIPs (80%), Wrist 80%, Knee 80%, Ankle Subtalar 80%, MTPs 90%, shoulder 60%, C-Spine 40%, TMJ 30%  
What joints are noticeably absent in involvement in R.A.   Spine except C-Spine  
Which hand joint is spared in R.A.   DIP joints are typically spared  
If you find ulnar deviations, interossei atrophy and subluxations what stage of R.A. is your patient in   advanced stages  
Outside of the joint you can get signs and symptoms of R.A. name 5   Rheumatoid Nodules, Sjogren's syndrome, Felty's syndrome, vasculitis, Rheumatoid lung, cardiac disease, neuromyopathy, inflammatory eye disease, osteoporosis, lymphadenopathy, hyperviscosity, cryoglobulinemia, dermatologic, amyloidosis  
If pt has rheumatoid nodules what other positive finding will you always find   Always Rheumatoid Factor +  
Your pt presents with R.A. and sever neck pain radiating to occiput, have diminished motor power in arms/legs, dysesthesias of the fingers/feet, marble sensation in the limbs/trunk, jumping legs, disturbed bladder function what could be causing this   Myelopathic leading to spinal cord damage from degeneration of the C-SPINE  
What is Sjogren's syndrome   autoimmune exocrinopathy, sicca symptoms (dry eyes, mouth, vagina, tracheo-bronchial dryness) associated with SS-A (RO) and SS-B (LA) antibodies and is tx symptomatically  
What is the schirmer's test for   tests for tear production can help identify Sjogren's or other malfunction in tear formation  
What are nail fold infarcts   small vessel vasculitis that can indicated R.A.  
What lab findings are you likely to find in R.A.   + rheumatoid factor, Anti CCP antibody, Elevated ESR or CRP, Anemia, Thrombocytosis, ANA +, Hyperglobulinemia, Leukopenia/granulocytopenia, glucose in body fluids very low  
Besides R.A. what other disease may show rheumatoid positive finding   Syphilis, sarcoidosis, SLE, SBE, T.B., Leprosy, Parasitic infections, Viral Disease, advanced age, autoimmune disease  
What are the two areas of R.A. that we can effectively tx   alleviate pain, slow rate of joint damage  
What is one of the limitations of DMARDs for tx of R.A.   high discontinuation rate (toxicity/efficacy) needs continued monitoring, has delayed onset of action  
What type of drug are these- Hydroxychloroquine (Plaquenil), Sulfasalazine (Azulfidine), Gold Compounds, Azathioprine (Imuran), D-Penicillamine (D-pen & Cuprimine), Cyclosporine (Sandimmune), Methotrexate (Rheumatrex, Trexall), Leflunomide (Arava)   DMARDs  
What are the pros of using methotrexate   long term clinical experience, favorable rate of continuing therapy, proven efficacy in moderate-severe RA  
What are the Cons of using methotrexate   Lab Monitoring 4-8wks, Toxicities; hepatic, myelosuppression, pulmonary  
What are the pros of using Leflunomide   Well absorbed PO, early onset of action, stabilized benefit for long-term use, selectively target autoimmune lymphocytes to reduces AEs  
What are the cons of Using Leflunomide   Lack of Clinical Experience, Toxicities- hepatic, GI, Teratogenic  
How does etanercept (Enbrel) help tx RA   Soluble TNA alpha receptor binds TNF-alpha a pro inflammatory cytokine helps reduce inflammation  
When would etanercept be indicated   moderate to severe RA prior DMARDS failure  
What are the adverse rxn from using etanercept   injection site reaction, infection (including TB), Cephalgia, Rhinitis  
How does Infliximab (Remicade) work in tx of RA   Chimeric Monoclonal anti-TNF antibody, blocks action of TNF has rapid onset of action used in combo with MTX  
When would Infliximab be indicated for use   Moderate to Severe RA with prior DMARDS failure  
What are the adverse rxns of using Infliximab (Remicade) in RA   URI, cephalgia and Nausea, Increased incidence of TB  
How does Adalimumab (Humira) work in tx of RA   Fully humanized monoclonal anti-TNF antibody blocks action of TNF, used in combo with MTX, rapid onset of action  
When would you use Adalimumab in tx of RA   moderate to severe RA prior DMARDS failure  
What are the s/e to using Adalimumab (Humira)   URI, Cephalgia, Nausea, increased incidence of TB  


   






 
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