Term
| Can you have RA even if you test negative for RF? |
|
Definition
|
|
Term
| What are acute phase reactants that can aid in diagnosing rheumatological problems? |
|
Definition
|
|
Term
| What can cause false increases in ESR? |
|
Definition
increased age
obesity
female sex |
|
|
Term
| Which has a more abrupt rise and fall, ESR or CRP? |
|
Definition
|
|
Term
|
Definition
| 24-72 hours after inflammation sets off |
|
|
Term
| If a patient has a normal ESR and CRP, does that mean they do not have inflammation? |
|
Definition
|
|
Term
| What non-rheumatologic conditions can cause an elevated ANA? |
|
Definition
hep C
thyroid disorders
polypharmacy
sometimes healthy patients |
|
|
Term
|
Definition
| measures the proportion of actual positives which are correctly identified as such |
|
|
Term
|
Definition
| measures the proportion of negatives which are correctly identified as such |
|
|
Term
| What condition does ANA have high sensitivity for? |
|
Definition
|
|
Term
| Why is it recommended to only order ANA in a patient if you suspect SLE based on history and exam? |
|
Definition
|
|
Term
| What is a weak test for polymyositis, dermatomyositis, RA, and Sjogren's syndrome? |
|
Definition
|
|
Term
| What test is not a positive predictor of scleroderma but is useful to rule it out? |
|
Definition
|
|
Term
| When should an ANA be ordered? |
|
Definition
| only if there is a high index of suspicion for a connective tissue disease |
|
|
Term
| What is rheumatoid factor? |
|
Definition
| antibody against the Fc portion of IgG (in clinical practice, measured as IgM) |
|
|
Term
| What can happen with a patient who has RA who initially tests negative for RF? |
|
Definition
| can seroconvert and test positive over time |
|
|
Term
| Only ___% of RA patients are positive for RF during early onset. |
|
Definition
|
|
Term
| What percentage of RA patients never test positive for RF? |
|
Definition
|
|
Term
| When should RF be ordered? |
|
Definition
| joint effusions and synovitis or erosive changes are seen radiographically (hands) |
|
|
Term
|
Definition
anti-cyclic citrullinated peptide
RA marker |
|
|
Term
| What is the major advantage of anti-CCP? |
|
Definition
increased specificity (90-95%)
useful in determining prognosis of RA
may be present before disease manifests
good for pts. who are RF negative |
|
|
Term
| What are the different classes of drugs used for rheumatological problems? |
|
Definition
NSAIDs (including COX-2 inhibitors)
corticosteroids
DMARDs
biologics
analgesics |
|
|
Term
|
Definition
| disease-modifying anti-rheumatic drugs |
|
|
Term
| What is a good COX-2 inhibitor? |
|
Definition
|
|
Term
| What is a major side effect of NSAIDs? |
|
Definition
|
|
Term
|
Definition
ibuprofen (Motrin)
naproxen (Aleve) |
|
|
Term
| What are prescription NSAIDs? |
|
Definition
naprosyn (Naproxen)
mobic (Meloxicam)
diclofenac (Voltaren)
relafen (Nabumetone)
celecoxib (Celebrex) |
|
|
Term
| What advise needs to be given to any patient on NSAIDs? |
|
Definition
| stop medication immediately if stomach upset or blood in stool and contact you (COX-2 inhibitors less likely to cause this) |
|
|
Term
| Why is mobic (Meloxicam) a good prescription drug to use? |
|
Definition
|
|
Term
| Why were the other COX-2 inhibitors (Vioxx, Bextra) pulled from the market? |
|
Definition
| increased cardiovascular risks |
|
|
Term
| What is a great drug for patients who cannot tolerate NSAIDs or have contraindications to them? |
|
Definition
|
|
Term
| Is Celebrex generally safe with patients on blood thinners? |
|
Definition
|
|
Term
| Celebrex is great for __________ pain (especially in orthopedics), but is contraindicated with this type of pain with ______. |
|
Definition
|
|
Term
| What monitoring tests need to be done periodically in a patient who is on long-term NSAID therapy? |
|
Definition
| kidney and liver function tests |
|
|
Term
| What are the main corticosteroids used in orthopedics? |
|
Definition
prednisone
medrol dose pack |
|
|
Term
| What are the side effects of corticosteroids? |
|
Definition
AVN
drug-induced secondary adrenocortical insufficiency
tendon ruptures |
|
|
Term
| What conditions do you need to be careful with in giving corticosteroids (oral or injectable)? |
|
Definition
seizure disorders (can lower threshold)
glaucoma
diabetes |
|
|
Term
| What is included in a corticosteroid injection? |
|
Definition
| steroid and lidocaine (NO epinephrine!) |
|
|
Term
|
Definition
viscosupplementation
one time injection (no need to return to clinic each week for 2 more injections like with original Synvisc) |
|
|
Term
|
Definition
viscosupplementation
5 week series of injections |
|
|
Term
| What allergies do you need to check for before giving patients viscosupplementation injections? |
|
Definition
|
|
Term
| What is the order of preferred treatments for arthritis? |
|
Definition
1. watch and wait
2. oral anti-inflammatories and/or PT
3. steroid injections
4. viscosupplementation
5. joint replacement/arthroscopy |
|
|
Term
|
Definition
| help slow down the joint destruction process of the disease |
|
|
Term
| What conditions are DMARDs used for? |
|
Definition
RA
ankylosing spondylitis
psoriatic arthritis
cancer
inflammatory bowel disease
reduce risk of transplant rejection |
|
|
Term
| How should DMARDs be started? |
|
Definition
|
|
Term
| What is the most commonly prescribed DMARD? |
|
Definition
|
|
Term
| How is methotrexate monitored? |
|
Definition
liver function
blood counts |
|
|
Term
| How can the side effects of methotrexate be reduced? |
|
Definition
|
|
Term
| What used to be the mainstay for treatment of RA until the mid 1980's? |
|
Definition
|
|
Term
| What drug is used to treat malaria but also has some benefit for RA? |
|
Definition
| Plaquenil (hydroxychloroquine) |
|
|
Term
| What major side effects can occur with Plaquenil? |
|
Definition
retina problems (rare)
decreased WBC
hematuria, proteinuria |
|
|
Term
|
Definition
Arava (leflunomide)
cyclosporine
Azulfidine (sulfasalazine)
Imuran (azathioprine)
Cytoxan (cyclophosphamide) |
|
|
Term
|
Definition
genetically engineered proteins derived from human genes
inhibit specific components of the immune system involved with the inflammatory process
used to treat moderate to severe RA that has not responded to other treatments |
|
|
Term
| What class of drugs can cause a dormant disease (such as TB) to flare? |
|
Definition
biologics
(test for TB before starting drug) |
|
|
Term
| What are contraindications for biologics? |
|
Definition
|
|
Term
|
Definition
injection or IV
(no oral form yet) |
|
|
Term
| What risks do biologics have? |
|
Definition
increased risk for infections
may develop local rash
no vaccines while taking these drugs |
|
|
Term
| What drugs are biologics that reduce inflammation and damage from RA by blocking TNF? |
|
Definition
Remicade
Enbrel
Humira
Cimzia
Simponi |
|
|
Term
| What drug is the first interleukin-6 inhibitor for RA? |
|
Definition
|
|
Term
| What biologic drug blocks the action of the chemical messenger interleukin-1 in RA? |
|
Definition
|
|
Term
| What biologic drug blocks signals needed to activate T-cells of the immune system? |
|
Definition
|
|
Term
| What biologic drug is given to patients who have not responded to TNF-blockers? |
|
Definition
|
|
Term
| Is arthritis treatable with narcotics? |
|
Definition
| NO! only good for acute flare up or acute injury |
|
|
Term
| What analgesic is safe in pregnancy? |
|
Definition
|
|
Term
| Is it okay to take Tylenol with an NSAID? |
|
Definition
|
|
Term
| What analgesic drug is good as a step-down medication from narcotics? |
|
Definition
|
|
Term
| What is a contraindication for Ultram (tramadol)? |
|
Definition
|
|
Term
| Who is Tylenol #3 good for? |
|
Definition
kids
adults who can't swallow pills |
|
|
Term
| What drugs make up Vicodin? |
|
Definition
| acetaminophen and hydrocodone |
|
|
Term
| What type of analgesic would you want to stay away from in a patient who has abnormal LFTs? |
|
Definition
|
|
Term
| What type of analgesic would you want to stay away from in a patient who has kidney dysfunction? |
|
Definition
|
|
Term
| What analgesic can you use in a patient who has really really bad liver dysfunction? |
|
Definition
vicoprofen (vicoden and ibuprofen)
but make sure kidneys are okay first |
|
|
Term
| What characterizes an inflammatory disorder? |
|
Definition
| destruction of a joint due to significant amount of inflammatory cells that attack the joint |
|
|
Term
| What things can result from an inflammatory disorder? |
|
Definition
constitutional symptoms (fever, malaise, weight loss, fatigue)
damage to internal organs
disability
death |
|
|
Term
| What are examples of inflammatory disorders? |
|
Definition
RA
SLE
psoriatic arthritis
gout
infectious arthritis
ankylosing spondylitis |
|
|
Term
| ________ disease is central to RA with a background of __________ and ___________ manifestations. |
|
Definition
| joint; constitutional; internal |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| What is the goal of treatment for RA? |
|
Definition
slow down or stop progression
improve quality of life
decreased signs and symptoms |
|
|
Term
| What are symptoms of early RA? |
|
Definition
| fatigue, malaise, viral-type feeling, joint pain, swelling, stiffness, tenderness, mild limitation in function and ROM |
|
|
Term
| What are symptoms of advanced RA? |
|
Definition
| increased fatigue, weight loss, overall dysfunction, joint damage and erosions, joint space narrowing, internal organ damage with severe disease, shortened life span unless disease is suppressed |
|
|
Term
| Who is RA more common in? |
|
Definition
| women before age 60, but then equal in both sexes after 60 |
|
|
Term
| What are the most common body parts affected by RA? |
|
Definition
|
|
Term
| What does a patient need to be started on within the first 2-3 months after RA onset in order to prevent joint damage and dysfunction? |
|
Definition
|
|
Term
| Can DMARDs and NSAIDs be used together for RA? |
|
Definition
|
|
Term
| What non-pharmacologic therapies are important for RA? |
|
Definition
|
|
Term
| What is the goal for early treatment of RA? |
|
Definition
|
|
Term
| Do not give a steroid injection if __________ is suspected! |
|
Definition
|
|
Term
| What condition presents with RA-like symptoms? |
|
Definition
|
|
Term
| Who is more commonly affected by SLE, men or women? |
|
Definition
| women (8-9 times more than men) |
|
|
Term
| What is the most commonly affected age group for SLE? |
|
Definition
| 20-45 (although can occur at any age) |
|
|
Term
| What nationalities have higher prevalence of SLE? |
|
Definition
|
|
Term
| What are the manifestations of SLE? |
|
Definition
BUTTERFLY RASH
fever
kidney and heart involvement
pleurisy
blood test abnormalities |
|
|
Term
| What blood test will usually be elevated with SLE? |
|
Definition
|
|
Term
| What is the most common symptom of SLE? |
|
Definition
joint pain
most develop arthritis (fingers, hands, wrists, knees) |
|
|
Term
|
Definition
|
|
Term
| What is treatment of SLE aimed at? |
|
Definition
|
|
Term
| What can mild cases of SLE be treated with? |
|
Definition
NSAIDs
topical corticosteroids
Plaquenil
low dose oral corticosteroids
pt. need to wear protective clothing, sunglasses, and sunscreen! |
|
|
Term
| What type of lupus is associated with the skin? |
|
Definition
discoid lupus
painless, does not itch, but scarring can cause alopecia |
|
|
Term
| What is the characteristic finding of SLE? |
|
Definition
| butterfly rash (painless, does not itch) |
|
|
Term
| What is Raynaud's phenomenon associated with? |
|
Definition
|
|
Term
| What is Raynaud's phenomenon? |
|
Definition
blood supply to the fingers and/or toes becomes compromised upon exposure to cold, causing blanching, whitish and/or bluish discoloration
pain and numbness in the exposed fingers and toes may occur |
|
|
Term
| How may criteria are there for SLE? |
|
Definition
| 11 (sometimes can be diagnosed with only 4) |
|
|
Term
|
Definition
| non-contagious common skin condition that causes rapid skin cell production resulting in red, dry patches of thickened skin |
|
|
Term
| Where is psoriasis common? |
|
Definition
extensor surface of elbows and knees
scalp |
|
|
Term
| When does psoriatic arthritis occur? |
|
Definition
|
|
Term
| What is a distinguishing feature of psoriatic arthritis that is not found in RA? |
|
Definition
| involves joints at the tips of the fingers |
|
|
Term
| What tests can be utilized for the diagnosis of psoriatic arthritis? |
|
Definition
x-rays
joint aspirations
HLA-B27
ESR
RF |
|
|
Term
| What are the treatments for psoriatic arthritis? |
|
Definition
NSAIDs
topical steroids for the rash
Plaquenil
DMARDs
oral steroids |
|
|
Term
| What is the characteristic x-ray finding of psoriatic arthritis? |
|
Definition
"pencil in a cup"
distal head of a bone becomes pointed appearing as if it has been sharpened and the adjacent bone has become "saucerized" |
|
|
Term
| What joint does the "pencil in a cup" sign occur at with psoriatic arthritis? |
|
Definition
|
|
Term
| What do you need to make sure you rule out in a patient you suspect to have gout? |
|
Definition
|
|
Term
| What do x-rays of the hand show with gout? |
|
Definition
| oval periarticular erosions |
|
|
Term
| What is a distinguishing feature of gout on x-rays that is not present in RA? |
|
Definition
| preserved joint spaces and normal mineralization in the hand and wrist joints |
|
|
Term
| How is the diagnosis of gout confirmed? |
|
Definition
| uric acid crystals in joint fluid |
|
|
Term
| What is the treatment for acute gout flare ups? |
|
Definition
|
|
Term
| What is the long-term prophylactic treatment for gout? |
|
Definition
|
|
Term
| How does probenecid work? |
|
Definition
| increases uric acid excretion in urine |
|
|
Term
| When should probenecid be started? |
|
Definition
once an acute gouty attack has subsided
if pt. already on it, do not stop if they have gouty attack--just make sure they get colchicine to take care of the acute attack |
|
|
Term
| What needs to be checked before starting a patient on probenecid? |
|
Definition
| kidney function (may not be effective if GFR is low) |
|
|
Term
| How does allopurinol work? |
|
Definition
| blocks production of uric acid |
|
|
Term
| What drug is used for prophylactic treatment of gout? |
|
Definition
|
|
Term
| Can allopurinol be used in patients with poor kidney function? |
|
Definition
|
|
Term
| What can happen with initial treatment with allopurinol? |
|
Definition
|
|
Term
| What drug is used to suppress the inflammation causing pain in an acute gouty attack? |
|
Definition
|
|
Term
| What is a common side effect of colchicine? |
|
Definition
|
|
Term
| What do you do for a patient who has tophus gout? |
|
Definition
aspirate
put pt. on pain med and indocin |
|
|
Term
| When can infectious arthritis occur? |
|
Definition
| after systemic infection, STD, or open wound |
|
|
Term
| What are the most common pathogens associated with infectious arthritis in children? |
|
Definition
|
|
Term
| What are the most common pathogens associated with infectious arthritis in adults? |
|
Definition
gonococci
staph
strep
occasionally spirocetes (lyme disease, syphilis) |
|
|
Term
| What is the treatment for infectious arthritis? |
|
Definition
IV antibiotics
arthroscopy to clean out the joint |
|
|
Term
| What is ankylosing spondylitis? |
|
Definition
long-term disease that causes inflammation of the joints between the spinal bones and joints between the spine and pelvis
joints fuse over time |
|
|
Term
| Who is more commonly affected by ankylosing spondylitis, men or women? |
|
Definition
|
|
Term
| What is the most common age group for ankylosing spondylitis? |
|
Definition
|
|
Term
| What does the pain associated with ankylosing spondylitis generally begin? |
|
Definition
| SI joints, then spread to back |
|
|
Term
| With regard to ankylosing spondylitis, pain is usually __________ with activity and ___________ with rest. |
|
Definition
|
|
Term
| How is ankylosing spondylitis treated? |
|
Definition
NSAIDs
corticosteroids
TNF
cytotoxic drugs
PT
sleeping on the back to maintain posture
surgery |
|
|
Term
| What special test is used to diagnose ankylosing spondylitis? |
|
Definition
Schober test
tests the pt's ability to flex lower back |
|
|
