Rheumatoid Arthritis Flashcards
(5 cards)
What is RA?
Rheumatoid Arthritis is a multisystem inflammatory disorder with persistent synovitis affecting joint structure and function…
About 70% of sufferers have a good life and life expectancy, but 20% seriously affected
What causes (or triggers) RA?
Do not have a clear ‘cause’ but do know triggers include
* Emotional stress
* Physical stress - can get the affected gene to be expressed
* Smoking - starting or stopping
* Environment - varied, pollutants, pesticides etc
* Familial - genetic
* Hormones - changes to female hormones
* Infection - increase or decrease in immune activity
* Immune disturbances generally
* Others: ‘Bad’ Gut Bacteria or Poor Dental Health
Herbalists often focus on gut and liver health
What is the pathophysiology of RA?
Not fully understood.
* Synovitis occurs as a consequence of leukocyte infiltration into the synovium.
* The interior of the inflamed synovium becomes hypoxic (has an oxygen deficiency). Hypoxia, stimulates angiogenesis in the synovium.
* T cells cause production of IL-17, a potent cytokine that promotes synovitis (inflammation).
* Antigen-activated CD4+ T cells amplify the immune response.
* The release of cytokines, especially TNF-α, IL-6 and IL-1, causes further synovial inflammation.
* In addition to joint damage, cytokines promote the development of many systemic effects around other areas of the body with synovial aspects
The ‘battle’ goes on for a very long time and damages the ‘field’ that the battle takes place
What are the signs and symptoms of RA?
MSK Clinical features
* Multiple joint pains - usually starts in small joints, wrists, fingers, feet
* Joint stiffness - in early stages as the tissues tighten
* Joint subluxation - instability in the longer term due to damage on cartliege and bone
* Joint swelling - remissions and relapses
* Symmetrical distribution once established - unlike osteoarthritis
* Bursitis - inflamed bursa
* Rheumatoid Nodules - lumps under the skin, debris
* Deformities of certain types, as tendon moving in wrong direction
Systemic Clinical features
* Recurring fever - characteristic
* Eye problems - dry or red eyes due to inflammation
* Pleurisy - plura get inflamed
* Leucopoenia - reduction in white blood cells
* Pericarditis - pericardia gets inflamed
* Weight loss as condition drags on
* Fatigue & weakness
* Vasculitis - internal layer of medium sized blood vessels, tunica interna, get inflamed
Prevalence
* Ages of onset 30 and 60.
* Global prevalence: 46 per 100,000 population; women more prone than men.
* In USA, Asians and Hispanics have significantly lower incidence compared to Caucasians.
* In Europe: Highest – Lowest / 100,000 - Ireland 38, UK 31, Denmark 30, Norway 30, Sweden 30, Netherlands 29, Italy 20, Russia 8
What are typical tests and treatments for RA?
Tests
* Blood tests - FBC (full blood count), ESR, CRP; Anti-CCP antibody test which is RA specific, Antinuclear antibody test (ANA) , present in many autoimmune conditions
* Rheumatoid factor which is RA specific & HLA markers.
* Synovial fluid aspiration
* X-rays, US, MRIs, CTs
Pharma management
* NSAIDs - Ibuprofen, Diclofenac, Naproxen, Celecoxib (Celebrex) (COX-2 inhibitors, do less damage to stomach lining)
* Disease-modifying anti-rheumatic drugs (DMARDs) - Methotrexate, Leflunomide, Hydroxychloroquine, Sulfasalazine - moderate the immune reaction
* Biological treatments - Adalimumab, Etanercept, Infliximab
Physical therapies
* Lifestyle management
* Diet & nutrition
* Operative measures
* Synovectomy - synovium is taken off/ pannus removed as this is the ‘battlefield’.
* Tendon repair - they can snap
* Joint fusion to prevent deformity
* Joint replacement
Psycho-emotional support
