Module 3 - Rheumatoid Arthritis

Question 1

Rheumatoid Arthritis

Answer 1

Chronic systemic autoimmune disorder characterized by;
Abnormal overactive functioning of immune system
Inflammation of connective tissues primarily in joints
Chronic pain

Question 2

RA Clinical Manifestations

Answer 2

Symmetric Inflammation of peripheral joints
Marked pain, swelling and discomfort
Significant disabling morning stiffness
Fatigue and malaise
Weakness
Begins in small joints of hands, wrist and feet
Bilateral and symmetrical

Question 3

Extraarticular Features (outside of joint)

Answer 3

Fever, fatigue, anemia, lymph node enlargement, skeletal muscle atrophy, rheumatoid nodules, raynauds phenomenon, skin and mucosal manifestations, any organ system may be involved

Question 4

Rheumatoid Nodules

Answer 4

Vary in size,not painful unless joint inflammed

Question 5

Diagnostic Criteria for RA

Answer 5

M

Question 6

Diagnostic Criteria for RA

Answer 6

Must have at least 4

Morning stiffness lasting 1 hour for 6 weeks
Arthritis with swelling or effusion of 3 or more joints for at least 6 wks
Arthritis of the wrist, MCP, PIP joints for 6 wks
Symmetric Arthritis
Rheumatoid Nodules
Positive serum rheumatoid factor
Characteristic radiologic changes of RA

Question 7

Goals for RA treatment

Answer 7

Patient function - top priority
Reduce pain
Suppression of inflammatory processes
Preserve function, prevent deformities
Balance of rest and exercise

Question 8

RA Medications

Answer 8

Salicylates
NSAIDS
COX-2 Inhibitors
Corticosteriods
Imunnosuppresive Agents

Question 9

Salicylates

Answer 9

Inhibits synthesis of prostaglandin
Peak 5-30 min
Absorbed in stomach, metabolized by liver, excreted in urine
Take w/food, 30 min before planned activity
Contraindication: Impaired renal function, bleeding abnormalities
S/E: GI; ringing in ears

Question 10

NSAIDs

Answer 10

Inhibits prostaglandin synthesis
Take w/food
Drug to Drug Interactions
Antiplatlet/Anticoagulation - Increased risk of bleeding
Diuretics/Antihypertensives - Nephrotoxic and poor BP
control
S/E: GI Irritation, dyspepsia, bleeding

Question 11

DMARDs (Disease modifying Anti-Rheumatic Drugs)

Answer 11

Alters the course of inflammation (stops inflammation)