Rheumatoid Arthritis Overview
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Questions and Answers

Which of the following laboratory evaluations is NOT included in the assessment of rheumatoid arthritis?

  • C-reactive protein
  • Liver function tests (correct)
  • Complete blood cell count (CBC)
  • Erythrocyte sedimentation rate

Which condition is NOT a differential diagnosis for rheumatoid arthritis?

  • Systemic lupus erythematosus
  • Inflammatory bowel disease
  • Multiple sclerosis (correct)
  • Septic arthritis

What is a potential risk associated with Janus kinase inhibitors for patients over 50 years with cardiovascular risk factors?

  • Lower incidence of arthritis symptoms
  • Increased risk of neurological disorders
  • Major adverse cardiovascular events (correct)
  • Improved renal function

The 2010 EULAR classification criteria includes each of the following EXCEPT which of the following?

<p>Blood glucose levels (C)</p> Signup and view all the answers

Which clinical prediction rule is referenced for the assessment of undifferentiated arthritis?

<p>Leiden Clinical Prediction Rule (B)</p> Signup and view all the answers

What is the significance of having high-positive RF or ACPA in the context of rheumatoid arthritis (RA)?

<p>Indicates a higher likelihood of developing severe joint damage (B)</p> Signup and view all the answers

Which factor is NOT associated with an increased risk of extra-articular manifestations in rheumatoid arthritis patients?

<p>Having low-positive RF (D)</p> Signup and view all the answers

In the classification of RA, what is the scoring point for having normal CRP and normal ESR?

<p>0 points (B)</p> Signup and view all the answers

What does a duration of symptoms of less than 6 weeks indicate in terms of rheumatoid arthritis classification?

<p>It indicates likely not RA (B)</p> Signup and view all the answers

Which of the following represents a treatment goal for rheumatoid arthritis?

<p>Improve patient mobility and joint function (C)</p> Signup and view all the answers

What is the primary cause of death in patients suffering from rheumatoid arthritis?

<p>Cardiovascular disease (B)</p> Signup and view all the answers

What classification score indicates definite rheumatoid arthritis (RA)?

<p>6 points or more (C)</p> Signup and view all the answers

What is a primary objective of the treat-to-target approach in managing rheumatoid arthritis?

<p>To achieve rapid disease activity reduction and remission (D)</p> Signup and view all the answers

Which index is NOT mentioned as a tool to assess disease severity in rheumatoid arthritis?

<p>Rheumatoid Arthritis Assessment Tool (B)</p> Signup and view all the answers

How are large joints defined in the context of rheumatoid arthritis?

<p>Shoulders, elbows, hips, knees, and ankles (A)</p> Signup and view all the answers

Which classification is NOT included when discussing disease-modifying antirheumatic drugs?

<p>Novel gene therapy medications (D)</p> Signup and view all the answers

What treatments have been classified as standard of care before the development of DMARDs?

<p>Nonsteroidal anti-inflammatory drugs and glucocorticoids (C)</p> Signup and view all the answers

What does ACPA stand for in the context of rheumatoid arthritis?

<p>Anti-Cyclic Citrullinated Peptide Antibody (A)</p> Signup and view all the answers

Which factor is NOT a conventional measure of disease activity in rheumatoid arthritis management?

<p>Heart rate variability (B)</p> Signup and view all the answers

What does ACR/EULAR stand for in the context of rheumatoid arthritis?

<p>American College of Rheumatology/European League Against Rheumatism (A)</p> Signup and view all the answers

In the context of joint involvement assessment, what does 'synovitis' refer to?

<p>The presence of inflammation in the synovial membrane (D)</p> Signup and view all the answers

What advantage do bDMARDs have over csDMARDs according to the guidelines?

<p>They target specific components of the immune system. (B)</p> Signup and view all the answers

What does ACR recommend if treatment with one bDMARD fails?

<p>Switch to a similar bDMARD within the same class. (C)</p> Signup and view all the answers

Why do patients using DMARDs need to have routine vaccinations up to date?

<p>Because DMARDs increase the risk of infection. (B)</p> Signup and view all the answers

Which of the following statements about the efficacy of Anakinra is correct?

<p>It is less effective than other bDMARDs. (C)</p> Signup and view all the answers

How do insurance companies generally dictate the treatment sequence for patients?

<p>They often require a TNF inhibitor to be used first. (B)</p> Signup and view all the answers

What is a significant difference in monitoring between bDMARDs and csDMARDs?

<p>bDMARDs are better tolerated and require less frequent monitoring. (A)</p> Signup and view all the answers

Which statement accurately describes the cost difference between bDMARDs and csDMARDs?

<p>bDMARDs are generally more expensive than csDMARDs. (A)</p> Signup and view all the answers

What do EULAR guidelines say regarding the switching of bDMARDs?

<p>EULAR does not specify between switching classes or staying within the same class. (D)</p> Signup and view all the answers

Flashcards

Complete Blood Cell Count (CBC)

A blood test that measures the number of red blood cells, white blood cells, and platelets in the blood.

Comprehensive Metabolic Panel

A blood test that measures the levels of various substances in the blood, including glucose, electrolytes, and liver enzymes.

C-Reactive Protein (CRP)

A blood test that measures the level of C-reactive protein (CRP), which is a protein produced by the liver in response to inflammation.

Erythrocyte Sedimentation Rate (ESR)

A blood test that measures the rate at which red blood cells settle to the bottom of a test tube. It is a nonspecific indicator of inflammation.

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Rheumatoid Factor (RF)

A blood test that detects the presence of rheumatoid factor (RF), an antibody often found in the blood of people with rheumatoid arthritis.

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Small Joint Involvement

A classification criterion for rheumatoid arthritis (RA) based on the number of small joints affected. At least one small joint must be involved to meet this criterion.

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Serological Markers

A classification criterion for RA based on the presence of rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) in the blood. Different levels of these antibodies contribute to the score.

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Acute-Phase Reactants

A classification criterion for RA based on the presence of elevated levels of C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR). These indicate inflammation in the body.

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Duration of Symptoms

A classification criterion for RA considering the duration of symptoms. Symptoms lasting at least 6 weeks indicate a higher likelihood of RA.

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Extra-Articular Manifestations

Non-joint related manifestations of RA that can affect various organs. These symptoms can occur in patients with RA but are not directly involved with joint inflammation.

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Smoking and RA

A condition that increases the risk of extra-articular manifestations in patients with RA. It is associated with more severe RA and a higher risk of complications.

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Treatment Goals for RA

The main goals of RA treatment are to manage pain and inflammation, maintain joint function, and prevent disease progression. This involves different medications and lifestyle changes.

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Treat-to-Target Approach in RA

A treatment approach for rheumatoid arthritis (RA) that aims to quickly reduce disease activity and achieve remission.

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Joint Involvement in RA

A measure of the number of swollen and tender joints to assess disease activity in rheumatoid arthritis (RA).

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Large Joints in RA

Large joints include shoulders, elbows, hips, knees, and ankles.

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Small Joints in RA

Small joints are in the wrist and hand, excluding specific joints.

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Disease-Modifying Antirheumatic Drugs (DMARDs)

A group of medications used to treat rheumatoid arthritis (RA) that modify the disease process.

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Conventional Synthetic DMARDs (csDMARDs)

Traditional DMARDs that have been used for many years.

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Biologic DMARDs (bDMARDs)

Biologic DMARDs work by targeting specific parts of the immune system.

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Targeted Synthetic DMARDs (tsDMARDs)

A newer class of DMARDs that target specific molecules involved in RA.

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Standard Of Care Before DMARDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids were used before the development of DMARDs.

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What are bDMARDs?

Disease-modifying antirheumatic drugs (DMARDs) that target specific components of the immune system, leading to better tolerance and less frequent monitoring compared to csDMARDs.

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How are bDMARDs different from csDMARDs?

Conventional synthetic DMARDs (csDMARDs) are general immunosuppressive agents, while bDMARDs target specific components of the immune system.

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What is a common side effect of bDMARDs and tsDMARDs?

Despite their effectiveness, both bDMARDs and tsDMARDs increase the risk of infections.

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Compare the cost of bDMARDs and csDMARDs.

bDMARDs are typically more expensive than csDMARDs.

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Compare the effectiveness of bDMARDs and csDMARDs in slowing joint damage.

bDMARDs are considered superior to csDMARDs in slowing joint damage.

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What is the general consensus on bDMARDs and tsDMARDs?

While clinical guidelines don't recommend one specific bDMARD or tsDMARD over another, insurance companies often require the use of a TNF inhibitor first.

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What is the recommendation for treatment failure with bDMARDs?

If one bDMARD fails to provide desired results, the American College of Rheumatology recommends switching to a different bDMARD class.

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Why is vaccination crucial for patients taking bDMARDs?

Treatment with bDMARDs often requires routine vaccinations to minimize the risk of infections.

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What are TNF inhibitors?

Tumor necrosis factor (TNF) inhibitors are a type of bDMARD that targets TNF, a key inflammatory molecule.

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Study Notes

Rheumatoid Arthritis (RA)

  • Chronic inflammatory autoimmune disease causing joint inflammation, erosion, and deformity
  • Prevalence in North America is 0.5% to 1%
  • Associated with significant morbidity, disability, and increased mortality rate
  • Suspected in patients with joint inflammation, especially polyarthritis
  • Characterized by symmetrical small joint polyarthritis, morning stiffness, and constitutional symptoms
  • Extra-articular manifestations are common, affecting multiple body systems

Epidemiology and Pathophysiology

  • Affects approximately 0.24% of the global population
  • Multifactorial development, with genetic factors, female sex, and increasing age as risk factors
  • Middle-aged and older adults at higher risk, with peak diagnosis age varying among studies
  • Smoking associated with worse outcomes, including more significant joint disease, rheumatoid nodules, vasculitis, and pulmonary fibrosis
  • Lifestyle factors like fish-rich diet and smoking avoidance may be protective

Diagnosis

  • Patients present with symmetrical polyarthritis, primarily of small joints (hands), with effusion, erythema, warmth, and marked morning stiffness
  • Constitutional symptoms such as fever and weight loss may also be present
  • Laboratory tests include CBC, comprehensive metabolic panel, C-reactive protein, erythrocyte sedimentation rate, rheumatoid factor, and anti-cyclic citrullinated peptide antibodies
  • Differential diagnosis includes other rheumatologic diseases, infections, and osteoarthritis
  • Leiden clinical prediction rule for undifferentiated arthritis can aid in diagnosis (Table 1)
  • Risk scores > 6.5 indicate higher RA risk (Table 1)
  • Table 2 shows the 2010 ACR/EULAR classification criteria for RA

Extra-articular Manifestations

  • Common, affecting multiple organ systems (Table 3)
  • Increased risk in smokers, males, and those with seropositive RA
  • Cardiovascular disease (CVD) is the most common cause of death in RA patients
  • Extra-articular manifestations are less common with better RA control

Treatment

  • Goals include reducing pain and inflammation, improving quality of life, maintaining joint function, and preventing disease progression
  • Treat-to-target approach advocated by ACR and EULAR
  • Simple Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI) tools quantify disease severity
  • Treatments categorized as conventional synthetic DMARDs (csDMARDs), biologic DMARDs (bDMARDs), or targeted synthetic DMARDs (tsDMARDs) (Table 4)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids were previous standard of care
  • Important to update vaccinations in patients taking DMARDs (Table 5)
  • Lifestyle modifications may include exercise, diet, rehabilitation, and integrative interventions (helpful for better outcomes)

Prognosis

  • Patients with RA have an increased mortality rate, ranging from 2-fold to 60% increase in recent studies (worsening outcomes)
  • Comorbidities are common (cardiovascular disease, infections, chronic kidney disease, lymphoproliferative disorders, smoking).

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Rheumatoid Arthritis Diagnosis and Management for Family Physicians PDF

Description

Explore the key aspects of Rheumatoid Arthritis (RA), a chronic inflammatory autoimmune disease that primarily affects joint health. This quiz covers its prevalence, epidemiology, pathophysiology, and the impact on patients' lives. Test your knowledge about the risk factors and the clinical features associated with RA.

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