RA Pre-Lecture

Question 1

• ___ disease
• ___ joint involvement
• Most common systemic inflammatory disease

Answer 1

• chronic
• symmetrical

Question 2

EPIDEMIOLOGY

Age
– Occurs at any age
– Onset is usually between ___ - ___ years
– Shortens lifespan by 3 to 18 years

Sex
– ___ > ___ (6:1 for ages 14-45)

Race
– No discrimination

Answer 2

• 30-50
• female, male

Question 3

MHC

Major Histocompatibility Complex

HLA: Human Lymphocyte Antigen typing
– HLA-DR4
– HLA-DR1

TAKE HOME MESSAGE:
– Consider possibility of a ___ etiology/redisposition

Answer 3

genetic

Question 4

RA Progression

over time
inflammation ___ and disability ___

Answer 4

• decreases
• increases

Question 5

Prodromal Effects

• fatigue
• weakness
• loss of ___
• joint pain
• low grade ___
• stiffness + muscle ache -> joint ___

Answer 5

• appetite
• fever
• swelling

Question 6

DIAGNOSTIC CRITERIA

• ___ involvement
• serology
• duration of symptoms
• ___ phase reactants
• diagnosed with RA if there is a score of __ or more

Answer 6

• joint
• acute
• 6

Question 7

JOINT INVOLVEMENT

Most Common Joints:
- ___ , ___ , and ___

May Involve:
- Elbows
- Shoulders
- Hip
- Knees
- Ankles

Answer 7

• Feet
• Wrists
• Hands

Question 8

EXTRA-ARTICULAR MANIFESTATIONS

Answer 8

• rheumatoid nodules
• vasculitis
• pulmonary
• ocular
• cardiac
• Felty’s

Question 9

RHEUMATOID NODULES

Common: hands, elbows, forearms ( ___ points)

More common in ___ disease

20% of patients are affected

Asymptomatic = ___ intervention

Answer 9

• pressure
• erosive
• NO

Question 10

VASCULITIS

Inflammation of small, superficial blood vessels

Depends upon duration of disease

Stasis ulcers

Infarction -> ____

Answer 10

necrosis

fingie turin black

Question 11

PULMONARY

Pleural effusions

Pulmonary ___

Nodules

Rare: interstitial ___ or arteritis

Answer 11

• fibrosis
• pneumonitis

Question 12

OCULAR

___ sicca
- Itchy, dry eyes + inflammation
- ___ Syndrome (KS + RA)

Inflammation: sclera, episclera, cornea

Nodules

Answer 12

• Keratoconjunctivitis
• Sjogrens

Question 13

CARDIAC

Increased risk of CV ____

Pericarditis

___ abnormalities

Rare: myocarditis

Answer 13

• mortality
• mortalityConduction

Question 14

FELTY’S

• ___ megaly
• Neutropenia

Answer 14

• Splenomegaly

Question 15

Other EXTRA-ARTICULAR MANIFESTATIONS

Lymphadenopathy

___ disease (associated with treatment)

Thrombocytosis

Anemia

Answer 15

renal

Question 16

LABORATORY INDICATORS

• Anemia
• Thrombocytosis
• ___
• ___
• RF
• Anti-CCP/ACPA
• ANA
• Joint ___
• Radiographic findings

Answer 16

• CRP
• ESR
• aspirations

Question 17

ERYTHROCYTE SEDIMENTATION RATE (ESR)

• ___
• Normal = 0 – 20 mm/hr
• Elevated in RA (> 20)

Answer 17

• Non-specific

Question 18

C- REACTIVE PROTEIN (CRP)

• Normal: 0.0 – 0.5 mg/dL
• positive -> > 0.5 mg/dL
• > 10 mg/dL can indicate ___

Answer 18

bacterial infection

Question 19

RHEUMATOID FACTOR (RF)

• Antibody specific for ____
• Not all patients with RA diagnosis are RF+ (60-70% are RF+)

Answer 19

• IgM

Question 20

ANTI-CCP/ACPA

• High ___
• Present ___ in disease
• Predictive value for erosive disease
• Marker of ___ prognosis

Answer 20

• specificity
• earlier
• poor

Question 21

ANTINUCLEAR ANTIBODIES (ANA)

• Elevated titers suggest ___ disease
• More indicative of SLE
• Reported as a titer

Answer 21

• autoimmune

Question 22

JOINT ASPIRATION

• ___
• WBC: 5,000 – 50,000/ mm3
• Glucose: normal to ___ compared to serum

Answer 22

• Turbid
• low

Question 23

RADIOGRAPHIC CHANGES

• Joint space ___
• ___ of bone

Answer 23

• narrowing
• erosions

Question 24

POOR PROGNOSIS

PHYSICAL FACTORS
- Extra-articular manifestations
- Elevated ___ and ___
- High titers of ___
- Elevated ___ / ___
- Erosions on X-Ray
- Duration of disease
- Swelling of > ___ joints

Answer 24

• ESR, CRP
• RF
• anti-CCP/ACPA
• 20

Question 25

# DIFFERENCES FROM OA RA - any age - systemic involvement - ESR: elevated - inflammation: present - joint involvement: ___ : symmetric - am stiffness > ___ - osteophyte: absent ___: often present - RF: frequently positive - subcutaneous nodules: frequently present - swelling: diffuse symmetric - malaise, fatigue, musculoskeletal pain, fever

Answer 25

- bilateral - 1 hour - pannus

Question 26

# PHARMACOLOGIC TREATMENT (5)

Answer 26

NSAIDs Corticosteroids DMARDs Biologic Agents Anti-TNF Biologic Agents Non-TNF