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PHAR 255 Exam 2 > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

Define Rheumatoid ARthritis

A

an autoimmune condition leading to inappropriate immune system activity causing synovial and connective tissue inflammation

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2
Q

Patholgy RA. Cause?

A

Chronic inflammation  growth of tissue (pannus)  loss of bone and cartilage (bone revrsible, cartilage not)

Triggered by genetics and by a “stochastic” event

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3
Q

Consequences of inflammation

A

Loss of cartilage

Formation of scar tissue

Ligament laxity

Tendon contractures – joint to twist into locked position

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4
Q

RA Symptoms

A

Symmetrical joint pain and stiffness >6 weeks
Muscle pain
May have fatigue, weakness, low-grade fever, appetite decrease

Joint tenderness with warmth and swelling over affected joints
Rheumatoid nodules may develop (collection of fibrous scar tissue) – not painful unless effecting a nerve

Most commonly a rapid onset starting in peripheral joints

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5
Q

Difference between RA and Osteo

A
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6
Q

Joint Damage

A

Occurs early in the course of RA

30% of patients have bone erosion at time of diagnosis

Damage is irreversible

Functional loss follows

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7
Q

RA can also effect the….

A

Blood Vessels
Lungs
Eyes
Heart
Muscle
Bone
Skin
Hematologic abnormalities

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8
Q

Blood vessels

A

Rheumatoid vasculitis
Occurs with severe, long-standing RA
Leads to substantial morbidity
Can affect any blood vessel
Symptoms experienced depend on affected vessels
Only treatment: Aggressive treatment of RA itself

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9
Q

Lungs

A

Pleuritis, pleural effusion, fibrosis, pulmonary nodules
Drugs used to treat RA may also impact lung function

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10
Q

Eyes

A

Episcleritis, scleritis, uveitis and iritis
Painful, visual acuity loss

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11
Q

Heart

A

Pericarditis, myocarditis
Increase risk of CAD, heart failure and atrial fibrillation

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12
Q

Muscle

A

Generalized weakness and pain
From synovial inflammation, myositis, vasculitis
Steroid-induced

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13
Q

Bone

A

Osteopenia common
Local bone loss around affected joints

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14
Q

Skin

A

Rheumatoid nodules
Ulcers
Steroid-induced changes

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15
Q

Hematological

A

Anemia – not iron; anemia of. Chronic dx (chronic inflammation) – treat the inflammatory pathway

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16
Q

CANSOME ACHIEVE REMISISON IN RA?

A

Yes it is sposisble
Achieve remission or low disease activity

17
Q

REMISSION DEFINITION RA

A

Tender/swollen joint count <1
A measure of function based on the Health Assessment Questionnaire (HAQ)
CRP score <1
A physician global assessment <2
A patient assessment of global disease activity (PtGA) <2 – considering how much it effects there QOL

18
Q

GENERAL PRINCIPLE SOF RA TREATMENT

A

Early recognition and diagnosis
Significant damage occurs in first two years of disease

Early use of DMARDs
Start within 3m of diagnosis
Depending on severity, treat aggressively

Concept of “tight control”
Treat until remission or low disease activity
Quickly treat exacerbations
Aggressively add DMARDs or early switch
Adjunct NSAID / steroids
Frequent reassessment

4) Responsible NSAID and glucocorticoid use
Reduce / discontinue as disease enters remission

19
Q

NON-PHAR TX

A

Patient education

Rest important, but balance with activity

Reduce joint stress with RA friendly tools

Occupational and physical therapy

Diet / weight loss

Surgery

20
Q

MAin RA Drug Classes

A
21
Q

Role of Dmards

A

Slow onset of action
Controls symptoms
May delay or stop progression of disease
Requires regular monitoring

22
Q

DMARD Examples

A

Hydroxychloroquine
Sulfasalazine
Methotrexate
Leflunomide

23
Q

Hydroxychloroquine MOA

A

Inhibits neutrophils and chemotaxis; impairs complement system
- down stream effects of inflammatory response

24
Q

Sulfasalazine MOA

A

Prodrug metabolized into 5-ASA and sulfapyridine
Modulates mediators of inflammatory response; may inhibit TNF
Immune system

25
Q

Methotrexate MOA

A

Anti-folate  less DNA synthesis, repair, cellular replication and immune response
Often supplement witj folic acid

26
Q

Leflunonamide MOA

A

Inhibits pyrimidine synthesis, leading to anti-inflammatory effects
Modulates many signaling pathways

27
Q

Onset DMARDS

A

Hydroxychloroquine – 2-6 months

Sulfasalazine - 2-3 months

Methotrexate – 1-2 months

Leflunomide – 1-3 months

28
Q

Methotrexate DOse

A

Methotrexate – 7.5 to 25mg PO weekly
Titrate to target in most cases 
Renal dosing: eGFR 10 – 50ml 
May initiate at target dose in select patients

Target Dose: 15 mfg per week
Titrate: 7.5 mg per week, increase by 2.5-5 Q 1 month

Can be used in dialysis: reduce all doses by 50%

PHAR 255 Exam 2 (4 decks)

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