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Flashcards in 10 minute topic RA Deck (22):
1

Rheumatoid Arthritis

chronic, progressive, inflammatory, autoimmune disease
principally attacks the joints producing an inflammatory synovitis
symmetric, bilateral
has exacerbations and remissions

2

RA risk factors

Female
Age 20 to 50 years
Genetic predisposition
Relation to the Epstein-Barr virus
Stress

3

Early RA sx

fatigue
joint discomfort

4

RA sx

pain at rest and with movement
morning stiffness
pleuritic pain (on inspiration)
xerostomia (dry mouth)
anorexia
fatigue

5

Labs for RA

Anti CCP antibodies
RF antibody
ESR
C reactive protein
Antinuclear antibody
Elevated WBC

6

Anti CCP antibodies test

detects antibodies to cyclic citrullinated peptide (anti-CCP)
will be positive before sx develop
more sensitive than RF test

7

RF antibody test

Diagnostic level is 1:40 to 1:60 (expected reference range 1:20 or less)
Can be increased by other autoimmune diseases

8

ESR test

20 to 40 mm/hr is mild inflammation
40 to 70 mm/hr is moderate inflammation
70 to 150 mm/hr is severe inflammation
Can be increased by other autoimmune diseases

9

C reactive protein test

Shows response to anti-inflammatory therapy
can be done in place of ESR

10

Antinuclear antibody test

Can be increased by other autoimmune diseases
Shows antibodies produced against one's own DNA

11

RA diagnostic procedures

Arthrocentesis
X-ray

12

Arthrocentesis

Synovial fluid aspiration
there are increased WBCs and RF are present in the fluids
take tylenol for pain

13

x-ray for RA

used to determine the degree of joint destruction and monitor the progression of the disease
no need for CT or MRI if x-ray is used

14

Meds for RA

NSAIDS
Corticosteroids
DMARDs
Plasmaphoresis

15

NSAIDS

should get rx for acid lowering agent
first choice for pain

16

Corticosteriods

prednisone
strong anti-inflammatory medications
do not give for a long time
watch for cushingoid changes

17

DMARDs

Disease modifying antirheumatic drugs
slow the progression of RA and suppress the immune reaction to RA
take several weeks to work

18

DMARDs examples

Antimalarial agent – Plaquenil
Antibiotic – Minocin
Sulfonamide – Azulfidine
Biologic response modifiers – etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira) – mostly given subQ
Cytotoxic meds – methotrexate (Rheumatrex) – make sure client is not pregnant

19

Plasmaphoresis

only done for a life threatening exacerbation
removes antibodies from plasma

20

Sjogren's syndrome

complication of RA
dry eyes, dry mouth, dry vagina
obstructed secretory ducts

21

Secondary osteoporosis

complication of RA
immobilization of RA can lead to osteoporosis

22

Vasculitis

complication of RA
Organ ischemia
inflammation of arteries disrupts blood flow
smaller arteries most commonly effected