PHRM 825: RA Flashcards
(25 cards)
At what age does RA occur?
- Any age
- Shortens life span by 3-18 years
- Onset is usually between 30-50 years
In what gender is RA more common?
Female
What is RA?
-Chronic autoimmune disease
How does RA affect the joints?
- Synovial space in joints infiltrated with inflammatory cells (macrophage, t-cells, plasma cells)
- These release cytokines which are mediators of immune and inflammatory response leading to cellular proliferation and death (IL-1, TNF, IL-6, IL-7)
What is a pannus and how does it affect the joint?
- Pannus is inflamed proliferating synovium
- Invades cartilage and bone producing erosion which ultimately destroy joints
What is the clinical presentation of RA?
- Prodrome (non-specific symptoms)
- Stiffness/muscle ache
- Fatigue
- Joint pain
- Weakness
- Low grade fever
- Loss of appetite
What joints are most commonly affected by RA?
- Hands
- Wrists
- Feet
What extra-articular manifestations can someone with RA have?
- Rheumatoid nodules
- Vasculitis
- Pulmonary
- Ocular
- Cardiac
- Felty’s
What are rheumatoid nodules?
- Nodules located on pressure points
- Usually found in hands, elbows, and forearms
- More common in erosive disease
- 20% of pts affected
What is vasculitis?
- Inflammation of small, superficial vessels
- Depends upon duration of disease
- Associated with stasis ulcers
- Infarction can lead to necrosis
What pulmonary manifestations can someone with RA experience?
- Pleural effusions
- Pulmonary fibrosis
- Nodules
What ocular manifestations can someone with RA experience?
- Inflammation: sclera, episclera, cornea
- Nodules on sclera
- Keratoconjunctivitis sicca (itchy, dry eyes + inflammation)
What is Sjorgens syndrome?
Keratoconjunctivitis Sicca + RA
What cardiac manifestations can someone with RA experience?
- Increased risk of CV mortality
- Pericarditis
- Conduction abnormalities
What is Felty’s
Splenomegala (inflamed spleen) and neutropenia
What is the normal level for Erythrocyte Sedimentation Rate (ESR) and what is it in RA?
Normal: 0-20
Elevated in RA (>20)
What is the normal level for C-reactive Protein (CRP) and what is it when there is a bacterial infection present?
Normal: 0-0.5
Infection: 10
What percentage of patients are positive for Rheumatoid factor (RF+)?
60-70%
- Higher titers indicate more severe disease
- Not all patients with RA are RF+
What is the Anti-cyclic citrullinated protein antigody (Anti-CCP) or anti-citrullinated protein antibody (ACPA) lab test used for in RA?
- Highly specific
- Present earlier in disease
- Predictive value for erosive disease
- Marker of poor prognosis
What is the Antinuclear Antibodies (ANA) lab test used for in RA?
- Elevated titers suggest autoimmune disease
- More indicative of SLE
- Reported as a titer
What social factors indicate poor prognosis for RA?
- Low socioeconomic status
- Lack of formal education
- Psychosocial stress
- Poor HAQ scores
What physical factors indicate poor prognosis for RA?
- Extra-articular manifestations
- Elevated CRP and ESR
- High titers of RF
- Elevated anti-CCP/ACPA
- Erosions on X-ray
- Duration of disease
- Swelling of >20 joings
What are treatment goals for RA?
- Alleviate signs and symptoms
- Preserve function or improve/maintain functional status
- Prevent structural damage and deformity
- Control/avoid extra-articular manifestations
What are non-pharmacologic treatment options for RA?
- Education
- Emotional/support groups
- Rest
- Splints/prosthetics
- Physical therapy and occupational therapy
- Weight reduction
- Surgery
- Heat
