Rheumatic Disorders and RA Therapeutics Flashcards
What is RA?
An autoimmune disorder, rheumatoid arthritis occurs when your immune system mistakenly attacks your own body’s tissues. A systemic autoimmune disease of unknown cause with its primary manifestation in synovial tissues. Synovial tissues proliferate in an uncontrolled fashion resulting in stretching of tendon and ligaments and erosions of bone.
Who does RA affect the most?
usually women
peak onset is 40’s to 50’s for women
and is 60’s-80’s for men
What are the symptoms of RA?
- insidious onset with MORNING STIFFNESS and PAIN
- systemic, symmetrical polyarthritis of small joints
- synovial cysts
- Rheumatoid nodules –> common on olecranon
- other complications: interstitial lung disease, pericarditis, vasculitis
What lab results will you find in RA?
- anti-ccp
- rheumatoid factor
- ESR and CRP will be elevated
how long must you have symptoms to be diagnosed with RA?
more than 6 weeks.
What joints does RA affect?
- cervical spine
- MCPs and PIPs of hands and feet
- wrist
- shoulders
- elbows
- SI
- knee
- ankles
with RA, when will the stiffness improve?
after movement
Will RA show diagnostic changes on X-ray?
usually normal in first 6 months
then, changes are seen and are specific for RA
describe the treatment for RA?
go hard first with treatment.
- DMARDS–> first line
- Corticosteroids–> can be used for immediate relief before DMARDs take effect
- NSAIDs
What are the steroid guidelines for RA?
prednisone 10 mg/day
- avoid using steroids without DMARDs
- use them as a bridge to therapy of DMARDs
What two types of DMARDs are there?
- conventional
2. biologics
Describe methotrexate:
Widely used for RA since early 1980’s
Response Time: 1-2 months
Effectiveness: 80% +, long-term responses
Dose: 7.5mg to 25 mg/week (single dose) PO, SQ, IM
Toxicity: Mouth sores, N&V, liver, cytopenias, and pneumonitis (rare)
Monitoring: CBC, Albumin and ALT q 4-12 weeks
ONCE WEEKLY DOSE, GIVE WITH FOLIC ACID
*** be aware of pneumonitis
Describe hydroxychloroquine:
The easiest DMARD to take and monitor Response Time: 2 - 3 months Effectiveness: 60% Dose: 200 – 400 mg q day po Toxicity: Retinal (rare), CNS, GI Monitoring: Eye check up yearly Caveat: PREVENTS Diabetes in RA patients Safest to take Eye checks initially and then yearly after 5 years of treatment*
Describe sulfasalazine:
Response Time: 2-4 months
Effectiveness: 60 –70%
Dose: 1 – 3 grams q day
Toxicity: GI, neutropenia (rare), Liver (rare)
Monitoring: early monthly CBC, then similar to MTX
Caveat: Enteric coated tabs much better tolerated
Describe minocycline:
Response Time: 2-4 months
Effectiveness: 60 –70%
Dose: 1 – 3 grams q day
Toxicity: GI, neutropenia (rare), Liver (rare)
Monitoring: early monthly CBC, then similar to MTX
Caveat: Enteric coated tabs much better tolerated
Immunological
Promotes increased production of IL-10
Induces Lupus in some acne patients
Metalloproteinase Inhibition
Strong evidence in animal models of inflammatory and OA
Large NIH trial in process
Antibacterial
Not treating “the infectious cause of RA”
Treating non- specific activators of inflammatory response
