Continue for minor procedures. Stop etanercept 1wk before for major procedures. Plan surgery at the end of dosing interval for adalimumab and infliximab. Restart all 10-14days after.
EIP to EDC5
or EDQM to EDC piggyback transfer
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A 45-year-old woman with rheumatoid arthritis is being scheduled for a total knee athroplasty in 2 weeks. She is currently taking sulfasalazine, Penicillamine, and etanercept, a tumor necrosis factor inhibitor (aTNF-a). What changes should be made to her medication regimen prior to surgery?
Discontinuation of all three medications 1 weeks prior to surgery
Discontinuation of sulfasalazine 1 weeks prior to surgery, continuation of etanercept and penicillamine
Continuation of sulfasalazine, penicillamine, and etanercept
Continuation of sulfasalazine and penicillamine, discontinuation of etanercept 1 week prior to surgery
Continuation of penicillamine, discontinuation of sulfasalazine and etanercept 1 week prior to surgery
Select Answer to see Preferred Response
Which of the following is more likely to occur following a total knee arthroplasty without patellar resurfacing versus a total knee arthroplasty with patellar resurfacing in patients with rheumatoid arthritis?
Anterior knee pain
Extensor tendon rupture
Decreased quadriceps strength
Patellar clunk syndrome
Which of the following biologic agents commonly used to treat rheumatoid arthritis (RA) DOES NOT target tumor necrosis factor-alpha (TNF-alpha)?
Vaughn-Jackson syndrome in rheumatoid arthritis is best described as?
Cranial migration of the dens from soft tissue erosion and bone loss between occiput and C1&C2
Rupture of flexor pollicis longus in the carpal tunnel
Synovitis in the DRUJ leading to supination of the carpal bones away from the head of the ulna
Rupture of the hand digital extensor tendons
Synovitis of the MTP joints with eventual hyperextension deformity of the MTP
The perioperative use of which medication has been shown to increase the risk of post-operative infection following orthopaedic procedures in patients with rheumatoid arthritis (RA)?
Infliximab is a medication associated with opportunistic infections in patients with rheumatoid arthritis. What is the mechanism of action of Infliximab?
Inhibition of dihydrofolate reductase (DHFR)
Monoclonal antibody against CD20 on B-cell surface
Tumor necrosis factor inhibitor
Glucocorticoid receptor agonist
In the treatment of patients with rheumatoid arthritis, TNF-alpha is blocked by which of the following agents?
Which immunoglobulin subtype does the rheumatoid factor target?
Rheumatoid factor does not target an immunoglobulin
Which of the following medications when combined with methotrexate has been shown to be more effective than methotrexate alone in the treatment of rheumatoid arthritis?
Which of the following drugs is an IL-1 antagonist typically used as a second line agent in the treatment of rheumatoid arthritis?
A 64-year-old female with rheumatoid arthritis has decreased functional use of the left hand for activities of daily living. On physical examination she has fixed deformities of the metacarpophalangeal (MCP) joints as demonstrated in Figure A. A radiograph is shown in Figure B. Which of the following management options for the finger MCP joints most likely lead to the least amount of extensor lag and improvement of the ulnar drift at 1-year followup?
Tenosynovectomies with extensor indicis proprius (EIP) to EDQ transfer
Tenosynovectomies with extensor reconstructions (central slip imbrication, Fowler distal tenotomy)
Metacarpal joint resection arthroplasties with palmaris autograft interposition
Extensor tendon relocation, extrinsic tendon release, and metacarpophalangeal joint collateral ligament reefing
Metacarpophalangeal joint arthroplasties
A 43-year-old female with long-standing rheumatoid arthritis complains of right forefoot pain for several years. She has failed conservative treatment and radiographs are shown in Figure A. What is the most appropriate treatment?
Keller procedure with lesser metatarsal head resections
1st MTP joint fusion and lesser metatarsal head resections
1st MTP joint interposition arthroplasty and lesser MTP joint arthroplasties
A 64-year-old woman with a longstanding history of rheumatoid arthritis complains of finger dysfunction for the past 6 months. Figure A displays her hand during active extension of all fingers. Figure B displays her hand maintaining her fingers extended following passive extension. What is the next most appropriate treatment for the ring finger?
Spiral oblique retinacular ligament reconstruction
Sagittal band reconstruction
Lateral band reconstruction
Central slip reconstruction
Triangular ligament and transverse retinacular ligament reconstruction
Medical treatment targeting TNF-alpha has revolutionized which of the following diseases?
Hunter syndrome (type II mucopolysaccharidosis)
Hereditary vitamin D resistant rickets
Current Treatment of the Rheumatoid Forefoot: Mark Berkowitz, MD(CSFA #27, 2017)
HPI - 68 year old male patient presents with the chief complaint of bilateral hip and sacral pain. He has bilateral lower extremity paralysis since the age of ~20 after receiving the rabies vaccination. He is admitted for management of a grade 4 pressure ulcer of the sacrum.
What is the underlying diagnosis?