Rhuematoid Athritis Flashcards
(22 cards)
What is it
chronic systemic imflammed joints (synovial joint) autoimmune
remission and exacerbation
usually small joints then progress
rapidly progress
Who is at risk 5
women more than men 20-50 years genetic Epstein BARR Stress
Clinical manifestations 6
pain- Early AM pain last 30-40 min
swelling
erythema
warmth (spongy tissue)
immolized in active inflamm (extended time lead to contractr)
Raynauds phenom- white red blanching of hands
How onset of sympt occur 3
usually acute bilateral and symetrical
How would rheumatoid nodule RA
non tender
movable in SQ tissue
dissapear spontaneously
SS in articular systemic disease 4
fever
wt loss
anemia
lymph node enlargemnt
SS articular disease 5
neuropathy scelritis pericarditis splenomegaly (lungs heart skin) Sjorgrens syndrome (dry eyes dry mm )
Lab finding RA 4 and result meaning
Rhuematoif functn- (not diagnostic/ not r/o) higher titers can correlate c disease
ESR- significanly elevated
ANA- antinucl- positive (produced against own DNA)
Athrocentesis- cloudy milky yellow leukocytes synovial fluid
Minocycline- atbx-
EARLY Managemnt RA 5
goal relieve pain perserve joint fxn
education and sppt- arthritis found. alternate rest activity ASA or NSAID- inflamm and pain IM injectn GOLD DMARDS
ASA implent 5
how to take it
adverse rx
watch for
take c milk or food
4-6 hrs apart maintain blood levels - may need 12 a day
Adverse Rx- tinnitus (toxic), GI upset and bleed,
may need enteric coating
watch for blood in stool
NSAIDs implnt 3
med name
Se- 5
Contraindic.
cx-2 inhibitors celebrex
cannot take if allrgc to other NSAID
SE- GI bleed, abd pain, black tarry stool (upper bleed), sudden wt gain , edema
CAn affect kidney or liver
DMARDS
meds 2
teachings
PC
antirheumatic drugs improve quality life and decr pain
IT IS STANDARD TREATMENT
methotrexate
Hydrochloroquine (safetest DMARD but rental damage )
take > 3mo of onset
eye checks q 6-12 mo
PC- more infect bc its immunosuppressant
Moderate errosive disease RA moderate 6
4 additional meds
in adittion to early tx PT Other DMARDS- cyclosporine (imune modulat)added to methotr. Sulfasalazine, luflunomide, azathiopride Biological response modifiers
Sulfasal, luflunomide, azathiopride
PC
4 side effects
PC immunosupp incr risk for infection
SE- N/V/D anorexia headache
Azothioprine (imuran)
PC 3
hepatoxic and hematoxic
thrombocytopenia- platelet low
anemia
leukopenia low wbc
Biological Response Modif. meds 3 how to give function SE Contraindication good for
adalimamab and etanerecpt (sq inj x wk),
, infliximab (weekly at first then q 6-8 wks)
blocks protein (TNF) they have too much
slows damage and progression RA pts poor response to DMARDS
Se- serious infn
Contraindicated c hx of TB or LUPUS
expensive
Persistant erosive RA
5
Steriods- unrelieved inflammation or bridge until other meds work- may have to give inj in joint if PO not wrk
steriods also incr risk of osteporosis and fxr (2-5x)
not give for immun systm
Surgery for persistant erosive 4
synovectomy
arthridesis- fusion of joint element joint all togethr
arthroplasty- repair
Tennorrhaphy- suture tendon if ruptures
Advnace unremiting disease
PC
Immunosuppres meds
hi dose for DMARD- other methitrexate cyclosporin
(watch for bone marrow suppr anermia GI rash)
prosbra
apheresis
Rixutan
Most common problems for RA pts 6 and how to fx them
pain- analgesics hot wax or cold. meds before get up in am
morningn stiffness hot shower
sleep disturbance- short term low dose Evil paxil ZOLoft, dont sleep in recliner
altered mood
limited mobility- exercise EXTENSION
nutritional- anorexia wt loss anemia
fatique- rest period
Diet for RA pts 2
fish oil , flaxseed - may need to decrease doses for these
Avoid contractions 3
no pillows under knees or large pill on head bc get still too wuck
prone position at times
