Rheumatoid arthritis Flashcards Preview

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Flashcards in Rheumatoid arthritis Deck (27):
1

Rheumatoid arthritis

a chronic systemic inflammatory disease whose major manifestation is synovitis of multiple joints

2

What is the prevalence of RA and age of onset

1% and can begin at any age

3

Clinical presentation

symmetric swelling of multiple joints, tenderness and pain, stiffness >30 mins prominent in the am, recurring after daytime inactivity, and severe after strenuous activity

4

Common joints affected in RA

PIP joints of fingers, MCP, wrists, knees, ankles, and MTP most often

5

20% of pts have

subcutaneous rheumatoid nodules, commonly over bony prominences but also in bursae and tendon sheaths

6

Labs

Anti-CCP (most specific), RF, ANA

7

Rheumatoid factor

IgM ab directed against the Fc fragment of IgG, can occur in other autoimmune diseases including hep C, syphilis, TB, present in 70-80% of pts w/ established RA, not as sensitive in early stages

8

Imaging

specific, obtained during first 6 months, but usually normal, earliest changes occur in wrists or feet, later diagnostic changes of uniform joint space narrowing and erosions develop

9

Treatment objectives

reduce inflammation, preservation of function, prevention of deformity, joint rest, ice/heat, exercise, wt loss

10

Treatment success

requires early, effective pharm intervention, DMARD should be started as soon as diagnosis is certain

11

NSAIDs

provide symptomatic relief but do not prevent erosions or alter progression, only use in conjunction with other meds

12

Corticosteroids

low doses produce anti-inflammatory effect in RA and slow rate of articular erosion, multiple side effects limit long-term, often used as bridge for DMARDs to take effect

13

Methotrexate

initial synthetic DMARD, tolerated well and beneficial in 2-6 weeks

14

Side effects of methotrexate

gastric irritation, stomatitis, cytopenia, bone marrow suppression, hepatotoxicity

15

Lab monitoring with methotrexate

base line liver, monitor every 3 mon, CBC, HCG, kidney fun, glucose

16

Sulfasalazine

second line drug, do not give if ASA sensitive

17

Side effects of sulfalazine

neutropenia/ thrombocytopenia in 10-25%, HEMOLYSIS WITH g6pd DEFICIENCY

18

monitoring for sulfalazine

G6PD, CBC every 2-4 weeks for first 3 months then every 3 mon

19

Leflunomide

pyrimidine synthesis inhibitor

20

Side effects of leflunomide

diarrhea, rash, alopecia, hepatotoxicity, wt loss, teratogenic

21

Antimalareals

hydroxychloroquine sulfate is antimalarial agent often used, monotherapy only in mild disease, often in combo with DMARDs

22

Side effects of antimalareals

pigmentary retinitis which leads to visual loss, opthalmologic exam once/year

23

Minocycline

more effective than placebo, reserved for early mild cases, MOA unclear

24

TNF inhibitors

frequently added when pts do not respond to DMARDS or poor prognosis, etanercept, infliximab, abalimumab, golimumab, certilzumab pegol

25

TNF inhibitor cautions

increases risk of serious bacterial infection and granulomatous infection, reactivation of TB, should stop if develop fever, extreme caution in CHF

26

Course and prognosis

Months-years, deformities occur, ulnar deviation, boutonniere deformity, swan neck deformity, valgus deformity of knee, volar subluxation of MTPs

27

Adverse effects of RA

mortality associated with RA is largely due to CVD