Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSK Week 2 2017/18 > 2: Rheumatoid arthritis > Flashcards

2: Rheumatoid arthritis Flashcards

1
Q

What is the prevalence of rheumatoid arthritis in the population?

A

1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is early RA?

A

RA discovered <2 years after onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is advanced RA?

A

RA discovered >2 years after onset of symptoms

often irreversible changes will have occured at this point

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the definition of RA?

A

SYMMETRICAL inflammatory arthritis affecting PERIPHERAL JOINTS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

RA is (symmetrical / asymmetrical).

A

symmetrical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which joints are affected by RA?

A

Peripheral joints

1st and 2nd cervical joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

RA, if left untreated, can lead to irreversible joint damage and deformities which cause ___ ___ ___.

A

loss of function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which sex is more likely to develop RA?

A

Females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Mutations in which gene causes RA?

A

HLA-DR4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which lifestyle factor has an association with RA?

A

Smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which structure, lining the inside of synovial joints and tendon sheathes, is affected in RA?

A

Synovium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

RA affects any ___ joint.

A

synovial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which joints of the hand are affected by RA?

A

MCP joints

PIP joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which joints of the hand aren’t affected by RA?

A

DIP joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which spinal joints are affected by RA?

A

C1 and C2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Inflammatory mediators released during synovitis cause joint ___.

A

damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why does bone erode in RA?

A

Osteoclasts activated during inflammatory response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which immune cells are activated in RA?

A

Pretty much all of them

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What name is given to hypertrophic, inflamed synovium found in joints of RA patients?

A

Pannus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

In RA, antigen ___ cells present antigens to __ cells which go on to activate other immune cells and cause inflammation.

Which chemicals are released by immune cells and further the inflammatory response?

A

presenting, T cells

cytokines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Apart from the hand joints themselves, what other structures are affected in RA?

A

Tendon sheathes

called tenosynovitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What other lesion are inflamed tendon sheathes mistaken for?

A

Ganglion cysts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When is the ideal time to treat RA?

A

First 3 months following onset of symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Are RA patients always positive for rheumatoid antibodies?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

RA is an example of a (monoarthritis / polyarthritis).

A

polyarthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

90% of RA diagnoses are based on ___ and ___.

A

history

examination

27
Q

What are the symptoms of RA?

A

Pain

Swelling

Prolonged morning stiffness lasting > 30 minutes

28
Q

In blood tests of patients with RA, what is commonly raised?

A

Inflammatory markers

as it’s an inflammatory disease

29
Q

Which joints tend to be involved in RA?

A

Any synovial joints, but small joints of hands and feet (symmetrically)

30
Q

Which joints, if eliciting pain when squeezed, should raise suspicion of RA?

A

MCP joints

MTP joints

31
Q

Patients presenting with recurrent trigger finger should be suspected of having what?

A

RA

32
Q

What is carpal tunnel syndrome?

A

Compression of MEDIAN NERVE causing peripheral pins and needles

can be caused by synovitis compressing nerve in RA

33
Q

What is palindromic rheumatism?

A

Comes and goes in episodes

34
Q

Tenosynovitis tends to affect the (flexor / extensor) tendons.

A

extensor

35
Q

Loss of function

Patients with a poor __ __ should be suspected of having RA.

A

poor grip strength

36
Q

What are the two autoantibodies associated with RA?

A

Rheumatoid factor

Anti-CCP antibodies

37
Q

Which class of antibody is rheumatoid factor?

A

IgM

38
Q

The ___ of rheumatoid factor is quite poor.

A

sensitivity

39
Q

Even though rheumatoid factor and anti-CCP antibody are raised in patients with RA, does their absence rule it out?

A

No

some patients have RA without any autoantibodies

40
Q

The more RA antibodies present, the (better / worse) the prognosis.

A

worse prognosis

41
Q

Anti-CCP antibody is associated with what?

A

Smoking

42
Q

In the initial stages of RA, X-rays will be ___.

A

normal

43
Q

In untreated RA, osteoclasts erode the bone causing ___.

A

osteopenia

reduced bone density

44
Q

Why are X-rays of the hands and feet a baseline investigation for RA even if there may be no visible changes?

A

Cheap and reproducible, 10% of X-rays will have changes

You’ve got an image to compare later X-rays to

45
Q

What scan is used to identify erosions and make treatment changes?

A

Ultrasound

46
Q

What is the gold standard scan for RA, but is less commonly used due to its cost?

What can you see on it in addition to bone?

A

MRI scan

Tendons and soft tissue swelling

47
Q

What scoring system is used for disease activity in RA?

A

DAS 28

counts the 28 joints most commonly affected (sparing the DIPs, which aren’t affected)

48
Q

The lower the DAS28 score, the (better / worse) the prognosis for the patient.

A

better

49
Q

What drugs are used to treat RA?

A

NSAIDs

Steroids

DMARDs

Biologic agents

50
Q

What are disease modifying drugs for RA?

A

Drugs which reduce the activity of immune cells

51
Q

What is the most commonly used disease modifying drug?

A

Methotrexate

52
Q

Steroids are used liberally as a bridge between NSAIDs and ___.

Why?

A

disease modifying drugs e.g methotrexate

DMARDs take weeks - months to start working

53
Q

How are steroids administered in patients with RA?

A

Orally

Intramuscularly / intra-articularly

54
Q

How often do RA patients take methotrexate?

A

Weekly

55
Q

Why must the use of DMARDs be monitored?

A

Loads of side effects

56
Q

What is an important pulmonary side effect of methotrexate?

A

Causes pneumonitis (inflammation of the lungs)

NOT pulmonary fibrosis

57
Q

If patients fail to respond to NSAIDs, steroids and DMARDs, what other drugs can be used to try and treat RA?

A

Biologic agents

i.e monoclonal antibodies

58
Q

What do biologic agents do?

A

Block various parts of inflammatory pathway e.g TNF, T cells, B cells…

59
Q

The use of biologic agents makes patients prone to ___.

A

infection

60
Q

Which organism can re-activate due to the use of biologic agents?

A

Mycoplasma tuberculosis

61
Q

Which disease, amongst many others, must patients be screened for before commencing the use of biologic agents?

A

TB

62
Q

Patients on biologic agents must avoid which type of vaccine?

A

Live attenuated

63
Q

Untreated RA will result in hand and foot ___.

A

deformities

64
Q

Untreated RA causes joints to (sublux / dislocate).

A

sublux

MSK Week 2 2017/18 (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions