Questions and Answers
Which of the following are conventional DMARDs? (Select all that apply)
NSAIDs prevent the progression of rheumatoid arthritis.
False
What are the main adverse events associated with NSAIDs?
Dyspepsia, gastric or small bowel bleed/ulceration, renal insufficiency, CNS confusion.
The drug class that includes Infliximab and Etanercept is known as ______.
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What are signs of serious problems associated with Methotrexate? (Select all that apply)
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Match the following agents to their function:
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What is a major cause of death among patients using any medication group?
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Steroids conclusively affect disease progression in rheumatoid arthritis.
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What role did oral biologic DMARDs, such as JAK kinase inhibitors, play in the management of rheumatoid arthritis?
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Which therapeutic approach is considered the same for both osteoarthritis and rheumatoid arthritis at baseline?
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In the context of rheumatoid arthritis progression, what does the severity graph indicate about the relationship between duration of disease and level of disability?
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What class of medications does the term bDMARDs refer to in the treatment of rheumatoid arthritis?
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Which injection type is indicated for use in rheumatoid arthritis therapy but does not include Hylans?
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What is the recommended approach for managing rheumatoid arthritis (RA) to achieve optimal outcomes?
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Which of the following best describes clinical remission in RA?
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What co-morbid condition is considered an independent risk factor in patients with rheumatoid arthritis?
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What is the recommended waiting period after a live virus vaccination before starting biologic treatment?
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Which of the following vaccination strategies is appropriate for patients with rheumatoid arthritis?
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What is the estimated percentage of patients achieving complete remission in the current biologic era of RA treatment?
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Which of the following statements about steroid use in RA is accurate?
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What is a critical component of achieving immunological remission in RA?
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What characterizes osteoarthritis compared to rheumatoid arthritis?
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In the evaluation of symmetric polyarthritis, what does a positive rheumatoid factor suggest?
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What is the primary goal of treatment in rheumatoid arthritis?
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Which of the following statements regarding the relationship between systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) is accurate?
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What is a common characteristic of rheumatoid arthritis that distinguishes it from osteoarthritis?
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In which trimester does IgG transfer peak during pregnancy?
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Which of the following medications is considered safe during pregnancy?
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What is the recommended waiting period after stopping biological agents before vaccination can occur?
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Which condition is an independent risk factor for the development of osteoporosis in women?
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What is the effect of menopausal status on rheumatoid arthritis in women?
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Which of the following contraceptive methods may increase the risk of infection?
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What percentage of women with rheumatoid arthritis may experience a relapse postpartum?
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How long should women wait after stopping methotrexate before trying to conceive?
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Which characteristic is NOT a criterion for the diagnosis of Adult Still’s Disease?
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What is a common complication associated with Adult Onset Still’s Disease?
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Which treatment approach is most effective for patients with severe Adult Onset Still’s Disease who do not respond to NSAIDs?
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What typical lab finding is highly elevated in more than 70% of patients with Adult Onset Still’s Disease?
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What is the most notable feature of the rash associated with Adult Onset Still’s Disease?
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Which condition is predominantly featured in Felty’s Syndrome?
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Which of the following statements is true regarding the prognosis of Adult Onset Still’s Disease after 10 years?
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In the management of pregnancy for women with autoimmune disease, which aspect is most critical?
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What is a significant risk factor for Felty’s Syndrome as it relates to rheumatoid arthritis?
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Which of the following treatments for Adult Onset Still’s Disease has the highest risk of increased toxicity?
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Study Notes
Disclosures
- Steven C Kimmel has research support from various pharmaceutical companies, including Roche, Novartis, and Amgen.
- Other listed companies include Genetech, Wyeth, Centacor, and Pfizer among others.
Osteoarthritis and Rheumatoid Arthritis
- RA therapies initiate with the same baseline as osteoarthritis (OA), involving physical therapy and analgesics.
RA: Therapy
- Baseline treatment includes NSAIDs, steroid injections, and potential surgical interventions.
- Other therapeutic options consist of oral steroids, conventional DMARDs (cDMARDs), biologic DMARDs (bDMARDs), and JAK kinase inhibitors.
RA Linear Progression
- RA progresses through defined stages: early, intermediate, and late, with increasing inflammation and disability linked to disease duration.
- Early and late interventions significantly affect outcomes in disease severity.
RA Treatment Approaches
- Various medications for RA include:
- Biologic agents: target specific components of the immune system.
- Steroids: may provide rapid anti-inflammatory benefits but do not conclusively alter disease progression.
- NSAIDs: provide pain relief but do not prevent RA progression, with notable adverse effects including gastric issues and renal insufficiency.
NSAID Agents
- Commonly prescribed and available OTC, NSAIDs relieve pain but carry risks.
- Adverse effects include dyspepsia, gastrointestinal bleeding, renal issues, and possible cardiovascular concerns.
- NSAIDs represent a significant cause of mortality in certain medical groups.
Pros and Cons of Steroid Therapy
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Pros:
- Quick anti-inflammatory and immunosuppressive effects beneficial for bridging DMARD therapy initiation.
-
Cons:
- Long-term use can lead to adverse effects such as skin thinning and increased risk of infections.
- Steroid use can cause osteopenia and may decrease overall lifespan.
RA: Choice of cDMARD
- Mild features might warrant the use of Sulfasalazine or Hydroxychloroquine, avoiding use with specific contraindications.
- Aggressive features typically require Methotrexate or Leflunomide.
DMARDs: Risks
- All DMARDs can present serious side effects.
- Hydroxychloroquine can lead to retinal deposits after 5 years.
- Methotrexate poses risks to lungs, liver, and bone marrow, necessitating vigilant monitoring for toxicity.
RA: Biologic DMARDs
-
Available Biologic Agents:
- Infliximab: Chimeric anti-TNF-α monoclonal antibody.
- Etanercept: TNF-receptor fusion protein targeting TNF-α.
Disclosures
- Steven C. Kimmel, MD has received grant research support from various pharmaceutical companies including Roche, Novartis, Amgen, Genentech, and Pfizer.
Osteoarthritis and Rheumatoid Arthritis Overview
- Management of Rheumatoid Arthritis (RA) parallels Osteoarthritis (OA) focusing on physical therapy, analgesics, NSAIDs, injections, and surgery.
RA Therapy Options
- Baseline therapy includes physical therapy, analgesics, NSAIDs, and steroid injections.
- Conventional Disease-Modifying Anti-Rheumatic Drugs (cDMARDs) and biologic DMARDs (bDMARDs) are available for treatment.
- Oral biologic DMARDs, specifically JAK Kinase inhibitors, present new therapeutic options.
RA Linear Progression
- Disease progression illustrated in stages: early RA, intermediate, and late RA occurring over 0 to 30 years.
- Key markers include severity, inflammation levels, radiographic evidence, and disability.
Vaccination Guidelines
- Avoid live virus vaccines in RA patients and wait 4 weeks after live vaccination before initiating biologic treatments.
Current Management Approach
- Focus on early diagnosis and treating to a target based on objective disease activity measures.
- Emphasizes early introduction of cDMARDs and biologic agents, along with adequate control of co-morbid conditions.
Treat to Target Remission
- Clinical and immunological remission defined by low disease activity, absence of synovitis, and no evidence of ongoing disease via imaging or serology.
Co-Morbid Conditions Associated with RA
- RA increases the risk of osteoporosis and cardiovascular diseases.
- Updated vaccination recommendations for RA patients include killed virus vaccines like Shingrix, Fluviron, and Pneumovac.
Prognosis of RA
- Historical treatments yielded remission rates below 20%; biopharmaceutical advancements now show 60% complete remission rates.
Extrajoint Manifestations of RA
- Notable extra-articular conditions include rheumatoid nodules, uveitis, pulmonary diseases, cardiac issues, and skin manifestations.
Adult Onset Still's Disease (AOSD)
- Characterized by daily fevers, arthritis, and specific lab markers (Rheumatoid Factor and ANA levels).
- Complications can include pericardial tamponade and macrophage activation syndrome.
AOSD Treatment
- High doses of NSAIDs may provide relief, with steroids reserved for non-responders and severe cases, alongside DMARDs and biologics.
Felty's Syndrome
- Associated with seropositive RA, characterized by granulocytopenia and splenomegaly, treated with GM-CSF and standard RA therapies.
Women’s Health Considerations in RA
- High prevalence of autoimmune diseases in women, with emphasis on reproductive health during preconception, pregnancy, and lactation.
- Certain medications are safe during pregnancy, while others carry significant risks that necessitate careful planning.
Disability in Artistic Context
- The work and legacy of Pierre-Auguste Renoir illustrate the impact of rheumatoid arthritis on disability, contributing to discussions on patient experiences.
Differential Diagnosis in Symmetric Polyarthritis
- Interpretation of autoimmune markers assists in differentiating between RA and other conditions like SLE, with specific autoantibody testing informing the clinical picture.
Differences Between Osteoarthritis and Rheumatoid Arthritis
- Osteoarthritis is primarily degenerative, while rheumatoid arthritis is an inflammatory disease of uncertain origin.
- RA focuses on managing disease activity and improving function, often requiring surgical intervention only after other therapies fail.
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Description
Explore the complexities of osteoarthritis through the professional insights of Dr. Steven C Kimmel. This quiz delves into the details surrounding grant research support from various pharmaceutical companies and their implications on treatment. Consider the relationships between medicine and funding in the context of osteoarthritis management.
