Inflammatory Arthritis Flashcards
What is rheumatoid arthritis?
A chronic inflammatory autoimmune disease characterised by inflammation of the synovial joints.
This results in use-related pain, stiffness and loss of movement in the affected joints.
What is rheumatoid factor?
Is a protein produced by the immune system that can attack healthy tissue in the body.
What increases in the blood when there is inflammation in the body?
CRP = C-reactive protein ESR = Erthyrocyte sedimentation rate (ESR)
What does the ESR indicate?
The inflammatory activity in the body.
What does the CRP measure?
Blood test marker for inflammation in the body,
Explain the synovial joint inflammation process.
increased production of inflammatory proteins leads to enzymes activated that destroys the lining of the joint.
Which exposes the underlying bone resulting in pain.
What is the synovium?
connective tissue that lines inside of the joint capsule.
What are the risk factors of RA?
Genetics - predisposition
Lifestyle - smoking (causes faster loss of bone density), overweight
Gender - Women are more likely to develop RA than men.
Infection - Bacterial and viral DNA has been found in synovial membrane
what % of the population does RA affect?
0.5 - 1% of population, predominately women.
what are the 4 domains (criteria) in determining rheumatoid arthritis?
- Joint involvement
- Duration of synovitis
- Acute phase reactants
- Serology
What are the current tests available for RA?
Rheumatoid factor Anti-CCP antibodies ESR CRP DAS scores Ultrasound/MRI and X-rays to assess synovitis/angiogenesis/erosions
What is a DAS score?
Disease Activity Score is a measure of disease activity in RA.
- Count the number of swollen joints (out of 28)
- Count the number of tender joints (out of 28)
The score ranges between 2.0 - 10.0
What DAS score is considered ‘in remission’
less than < 2.6
What DAS score indicates low disease activity?
less than < 3.2
What does a DAS score greater than 5.1 imply?
active disease
What substances in the blood indicates RA?
Anti-CCP antibodies
Rheumatoid factor
What do NSAID drugs act on?
Inhibit COX-1 and COX-2 inhibitors of the inflammatory pathway.
Also has an impact on the gastro-protective pathways
What pain relief would be the first treatment choice for a patient who is breastfeeding?
Ibuprofen
Diclofenac
List non-selective Cox NSAIDs -
Ibuprofen Naproxen Diclofenac Indomethacin Piroxicam
List Cox-2 selective NSAIDs -
Celecoxib
Meloxicam
Why are patients with a higher risk of cardiac events not recommended Cox-2 selective NSAIDs?
COX-2 has a role in platelet function - inhibition of COX-2 LEADS TO MORE FREQUENT THROMBO-EMBOLIC EVENTS. = more myocardial infarctions
should only be used short term
What is the main cause of GI morbidity with NSAIDs use?
Gastric erosions
Gastric ulcers
Where are the adverse effects of NSAIDs?
Renal
GI tract
Why is non cox-2 selective NSAIDs better?
More efficacious
