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IPDM I WK 7 RA

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alchemist04's version from 2016-05-27 23:56

Section

Question Answer
What are the RA criteria? (1)(1) Morning stiffness lasting longer than 1 hr
What are the RA criteria? (2)(2) 3 or more joints soft tissue swelling
What are the RA criteria? (1)(3) Arthritis of joints
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Question Answer
What are the RA criteria? (2)(4) Symmetric involvement
What are the RA criteria? (1)(5) Subcutaneous/Rheumatoid nodules
What are the RA criteria? (2)(6) Positive serum rheumatoid factor
What are the RA criteria? (1)(7) Radiographic changes
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Question Answer
What are the risk factors for RA? (1)(1) Female (3x more likely than male)
What are the risk factors for RA? (2)(2) Increasing age (Peak from 35-50 yo)
What are the risk factors for RA? (3)(3) Smoking/nicotine dependence (smokers 2x more like)
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What are the risk factors for RA? (4)(4) Family history (presence HLA-DRBI gene of MHC)
What are the risk factors for RA? (5)(5) Stress
What are the risk factors for RA? (6)(6) Infections like DM type 2, Psoriasis
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Question Answer
What is DMARD?Disease modifying anti-Rheumatic Drugs
What are the examples of DMARD?(1) Traditional/convetional (oral) (2) Biologics/injections
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Question Answer
What are DMARDs traditional/conventional (oral)(1) Methotrexate (MTX), (2) Leflunomide (Arava) (3) Hydroxychloroquine (Plaquenil) (4) Sulfasalazine (Azulfidine)
Methotrexate brands?Trexall, Rheumatrex, Rasuvo
What is MTX dosing?7.5 mg PO/SC Qweek
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Question Answer
What are the 2 types of biologics?They are the monoclonial antibodies. (1) TFNi (2) Non-TFN (exclude Anakinra)
What is TNFi?(1) Etancept (Enbrel) (2) Infliximab (Remicade) (3) Adalimumab (Humira) (4) Golimumab (Simponi, Simponi Aria) (5) Certolizumab Pegol (Cimzia)
What are examples of TNFi?(1) Abatacept (Orencia) (2) Rituximab (Rituxan) (3) Tocilizumab (Actemra) (4) Anakinra (Kineret)
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Question Answer
What are example of Synthetic small molecule?Tofacitinib (oral) - Xeljanz, Xeljanz XR
When do you use glucocorticoids? (1)(1) If the disease flares, add short-term glucocorticoids at lowest possible dose and for shortest possible duration
When do you use glucocorticoids? (2)(2) If the disease activity remains moderate or high despite DMARD or biologics.
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Question Answer
If the disease activity is moderate or high in patients who have never taken a DMARD, what do you do? (1)(1) DMARD monotherapy is preferable over tofacitinib (do not use Tofacitinib for early RA)
If the disease remain moderate or high despite use of DMARD, TNFi, or non-TNFi biologic therapy what do you do?add short term glucocorticoids therapy
If the patient is in remission, what do you do (1)(1) Taper DMARD therapy
If the patient is in remission, what do you do (2)(2) Taper TNFi, non-TNFi biologics or tofacitinib
If the patient is in remission, what do you do (3)(3) Do not discontinue all RA therapies
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Question Answer
What would you recommend for early RA w/ Low activity? treat to target rather than non-target approach
What would you recommend for early RA w/ Low activity? in PT that has never taken DMAD?Use DMARD monotherapy over double or triple therapy
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What would you recommend for early RA w/ moderate or high in PT that has never taken DMARD ?: Use DMARD monotherapy over double or triple therapy
Question Answer
What would you do in early RA if disease remain moderate or high despite DMARD monotherapy w/ or w/o glucocorticodoid?Use combination DMARDs or a TNFi or a non-TNFi biologic (all choices w/ or w/o MTX, in no particular preference), rather than continuing DMARD monotherapy alone.
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Question Answer
What would you recommend for an established RA w/ low activity that has never taken DMARD before? Use DMARD monotherapy over a TNFi
What would you recommend for established RA w/ moderate or high in PT that has never taken DMARD? (1)(1) Use DMARD monotherapy over Tofacitinib
What would you recommend for established RA w/ moderate or high in PT that has never taken DMARD? (2)(2) Use DMARD monotherapy over combination DMARD therapy
What would you do in established RA if disease remain moderate or high despite DMARD monotherapy w/ or w/o glucocorticodoid?With DMARD, add another DMARD or TNFi or non-TFNi or Tofacitinib. It is better to combine rather than continuing the DMARD monotherapyly
What would you do in an established RA if disease remain high despite TNFi therapy in patient that is currently on DMARDs?Add 1 or 2 or more DMARDs to TNFi therapy rather than continuing therapy alone.
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