Term
| a degenerative diseasee involving primarily cartilage |
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Definition
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Term
| an inflammatory disease of unknown etiology |
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Definition
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Term
| most common form of arthritis |
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Definition
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Term
| increased mortality associated with this disease |
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Definition
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Term
| treatment is aimed at pain control and improvement/preservation of function |
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Definition
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Term
| treatment is aimed at controlling disease activity hopefully slowing the joint damage, alleviating pain, and maintaing function |
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Definition
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Term
| affects 16 million americans |
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Definition
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Term
| affets 2.1 million americans |
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Definition
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Definition
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Definition
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Definition
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Term
| female > male in certain joints (hands/knees) |
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Definition
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Term
| Abnormalities of collagen type II gene |
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Definition
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Term
| no association with HLA antigens |
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Definition
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Term
| HLA-DR4 increased in white patients |
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Definition
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Term
| HLA-DR1, DR10,DRw6 increased in non whites |
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Definition
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Term
| >5% retire from work annually due to |
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Definition
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Term
| 30% of patients with ___ will die within 25 years |
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Definition
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Term
| 50% are work disabled by 10 years |
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Definition
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Term
| life expetancy is 10 years < than general population |
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Definition
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Term
| in patients with severe disease, 5 year survival is 50% |
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Definition
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Term
| due to excessive load + normal joint, or normal load and defective joint |
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Definition
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Term
| due to genetic predisposition + environmental trigger, or autoimmunity |
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Definition
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Term
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Definition
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Definition
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Term
| pain with use, stiffness minor, limited motion |
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Definition
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Term
| pain at rest and use, morning stiffness, limited motion, fatigue, malaise, extraarticular symptoms |
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Definition
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Term
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Definition
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Term
| bony hypertrophy/tenderness |
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Definition
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Term
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Definition
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Term
| synovitis: joint swelling, tenderness, heat, redness |
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Definition
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Term
| joints: polyarticular, symmetrical, hands/wrists |
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Definition
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Term
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Definition
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Term
| diagnostic joints include wrist, 2/3 MCP/MTP |
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Definition
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Term
| Heberdens/bouchards nodes of hands |
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Definition
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Term
| most routine and serologic tests are normal |
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Definition
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Term
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Definition
| Rheumatoid factor, exray evaluation, CCP antibodies, ESR and c-rp, synovial fluid, routine labs |
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Term
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Definition
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Term
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Definition
not SLE.
possible RA or other immune stimulatory disease |
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Term
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Definition
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Term
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Definition
not SLE.
seroneg RA, spondyloarthropathy or other imune complex disease |
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Term
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Definition
| 31% patients, 85% with > 4 new erosions |
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Term
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Definition
| 37% patients, 47% with > 4 new erosions |
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Term
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Definition
| 14% patients, 33% with > 4 new erosions |
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Term
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Definition
| 18% patients, 0% with >4 new erosions |
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Term
| radiologically narrowing of joint spaces diffusely |
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Definition
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Term
| radiologically narrowing of joint spaces in weight bearing areas |
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Definition
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Term
| juxtra-articular osteopenia |
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Definition
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Term
| bony sclerosis and bone cysts |
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Definition
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Term
| morning stiffness less than 30 min |
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Definition
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Term
| morning stiffness more than 60 min for at least 6 weeks |
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Definition
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Term
| bony changes, tenderness, no inflammation |
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Definition
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Term
| swelling in 3+ joints, swelling in hand/wrist joints, |
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Definition
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Definition
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Definition
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| asymmetry of joint involvement |
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Definition
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Term
| symmetry of joint involvement |
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Definition
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Term
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Definition
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Term
| erosion on x rays, possible deformity |
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Definition
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Definition
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Definition
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Definition
| may decrease pain, chondroproductive in OA, decrease inflammation |
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Term
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Definition
| costs, unclear risks, drug interactions, aggravation o fdiabetes, not useful in RA |
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Term
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Definition
| severe pain, prevent constipation |
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Term
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Definition
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Term
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Definition
| celecoxib, rofecoxib, valdecoxib |
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Term
| adverse effects with NSAID use |
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Definition
| <1%. CNS - confusion, depression, heaache. hepatic, hematologic, rash, respiratory |
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Term
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Definition
| reduction of synovitis, decrease of flexion contracture, treatment of joint not fully responsive to systemic therapy |
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Term
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Definition
| fast acting, 3-4 times a year, side effects |
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Term
| hyaluronic acid derivative joint injections |
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Definition
hyalgen - 5 weekly injections.
synvise - 3 weekly injections |
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Term
| steroid injection complications |
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Definition
| flare, diabetes flare, infection, bleeding, allergy, hypopigmentation |
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Term
| hyaluronic acid injection complications |
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Definition
| flare, local irritation, infection, bleeding, rare allergy |
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Term
| arthroplasty sx indications |
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Definition
| severe symptoms with severe joint damage |
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Term
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Definition
| pain relief and realignment of joints with severe symptoms and focal damage but without complete loss of cartilage |
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Term
| bony decompression sx indications |
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Definition
| occassionally used in early osteonecrosis to relieve severe pain |
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Term
| joint debridement sx indications |
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Definition
| moderate to severe symptoms, especially mechanical type, without advanced loss of articular cartilage |
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Term
| arthroscopic washout or 'tidal irrigation' sx indications |
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Definition
| moderate to severe symptoms without severe radiographic changes useful in diagnosis, mainly used for the knee |
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Term
| indications for joint replacement |
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Definition
| persistent pain despite medical and PT, loss of joint function, fracture |
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Term
| absolute contra for joint replacement |
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Definition
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Term
| relative contra for joint replacement |
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Definition
| age, obesity, poor healthy, poor bone stock, deformities, prior infection |
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Term
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Definition
| PT, analgesics, NSAIDs, injections, sx, steroids (oral), DMARDs, biologic DMARD agents |
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Term
| RA pros of steroid therapy |
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Definition
| anti inflammatory and immunosupressive, can be used to bridge gap between initiation of DMARD therapy and onset of action, intra articular injections can be used for individual joint flares |
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Term
| RA cons of steroid therapy |
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Definition
| does not conclusively affect disease progression, tapering and discontinuation of use often unsuccessful, even low doess result in skin thinning, ecchymoses, infections, and cushingoid appearance, causes steroid induced osteopenia/increase osteosclerosis |
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Term
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Definition
| slow disease progression. improve functional disability, decrease pain, interfere with inflammatory process, retard development of joint erosions, improve life expectancy |
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Term
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Definition
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Term
| DMARDs with high toxicity |
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Definition
| cyclosporine, D-Penicillamine |
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Term
| DMARDs with moderate toxicity |
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Definition
| Gold (IM), leflunomide, methotrexate, azathiprine |
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Term
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Definition
| hydroxychloroquine, azulfidine, gold (oral) |
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Term
| RA choice of DMARD - mild features |
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Definition
| azulfidine, plaquenil (avoid if retinal disease) |
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Term
| RA choice of DMARD - aggressive |
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Definition
| methotrexate, leflunomide, imuran |
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Term
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Definition
MTX/SSA/HCQ.
MTX/CsA
MTX/Leflunomide |
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Term
| RA agents that do TNF inhibition |
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Definition
| infliximab, etanercept, humira, simponi, cimzia |
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Term
| RA agents that do IL inhibition |
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Definition
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Term
| RA agents that are cell inhibitors |
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Definition
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Term
| TNF antagonists contraindications |
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Definition
| MS, optic neuritis, current infection, chronic infect, history of TB, HEP B, CHF, lymphoma, live vaccines |
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Term
| non TNFi contraindications |
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Definition
| current infection, chronic infections, history of TB, Hep B, CHF, Lymphoma, live vaccinations |
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Term
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Definition
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Term
| RA therapy if infection risk |
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Definition
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Term
| RA therapy if azathioprine |
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Definition
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Term
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Definition
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Term
| RA treatment - no response at 3 months |
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Definition
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Term
| RA treatment - some response at 3 months |
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Definition
| continue for 3 more months and adjust treatment |
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Term
| RA treatment - achieve LDAS at 6 months |
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Definition
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Term
| RA treatment - failure to achieve LDAS at 6 months |
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Definition
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Term
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Definition
| osteoporosis, CV disease, no live vaccines should be given |
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Term
| RA extraarticular disease |
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Definition
| rheumatoid nodules, ocular involvement, pulmonary disease, cardiac, neurologic, skin |
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Term
| adult onset Still's disease |
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Definition
| faint salmon colored rash, most common on trunk and upper extremities, face |
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Term
| adult onset stills disease complications |
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Definition
| pericardial tamponade, myocarditis, pneumonitis, intravascular coagulopathy (DIC), increasing LFT |
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Term
| adult onset stills disease treatment |
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Definition
nsaids (high doeses, 1/4 will respond.
steroids (severe cases).
DMARDs.
biologic therapy (IL-1, TNFi) |
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Term
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Definition
| seropositive RA, splenomegaly, granulocytopenia |
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Term
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Definition
| contraception necessary after certain meds, pregnancy - remission, no risk for fetus from meds, menopause - increased risk of RA/coronar risk/osteoporosis |
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