10 minute topic RA Flashcards
Rheumatoid Arthritis
chronic, progressive, inflammatory, autoimmune disease
principally attacks the joints producing an inflammatory synovitis
symmetric, bilateral
has exacerbations and remissions
RA risk factors
Female Age 20 to 50 years Genetic predisposition Relation to the Epstein-Barr virus Stress
Early RA sx
fatigue
joint discomfort
RA sx
pain at rest and with movement morning stiffness pleuritic pain (on inspiration) xerostomia (dry mouth) anorexia fatigue
Labs for RA
Anti CCP antibodies RF antibody ESR C reactive protein Antinuclear antibody Elevated WBC
Anti CCP antibodies test
detects antibodies to cyclic citrullinated peptide (anti-CCP)
will be positive before sx develop
more sensitive than RF test
RF antibody test
Diagnostic level is 1:40 to 1:60 (expected reference range 1:20 or less)
Can be increased by other autoimmune diseases
ESR test
20 to 40 mm/hr is mild inflammation
40 to 70 mm/hr is moderate inflammation
70 to 150 mm/hr is severe inflammation
Can be increased by other autoimmune diseases
C reactive protein test
Shows response to anti-inflammatory therapy
can be done in place of ESR
Antinuclear antibody test
Can be increased by other autoimmune diseases
Shows antibodies produced against one’s own DNA
RA diagnostic procedures
Arthrocentesis
X-ray
Arthrocentesis
Synovial fluid aspiration
there are increased WBCs and RF are present in the fluids
take tylenol for pain
x-ray for RA
used to determine the degree of joint destruction and monitor the progression of the disease
no need for CT or MRI if x-ray is used
Meds for RA
NSAIDS
Corticosteroids
DMARDs
Plasmaphoresis
NSAIDS
should get rx for acid lowering agent
first choice for pain
Corticosteriods
prednisone
strong anti-inflammatory medications
do not give for a long time
watch for cushingoid changes
DMARDs
Disease modifying antirheumatic drugs
slow the progression of RA and suppress the immune reaction to RA
take several weeks to work
DMARDs examples
Antimalarial agent – Plaquenil
Antibiotic – Minocin
Sulfonamide – Azulfidine
Biologic response modifiers – etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira) – mostly given subQ
Cytotoxic meds – methotrexate (Rheumatrex) – make sure client is not pregnant
Plasmaphoresis
only done for a life threatening exacerbation
removes antibodies from plasma
Sjogren’s syndrome
complication of RA
dry eyes, dry mouth, dry vagina
obstructed secretory ducts
Secondary osteoporosis
complication of RA
immobilization of RA can lead to osteoporosis
Vasculitis
complication of RA
Organ ischemia
inflammation of arteries disrupts blood flow
smaller arteries most commonly effected
