RA Flashcards
definition
RA is a chronic progressive autoimmune disease.
It is characterized by persistent inflammation of the synovial joints as well as inflammation of extra-articular sites.
WHO IS AT RISK - and age and gender (Ray can be young)
Gender: 75% of affected are women.
Age: onset can be any age. Usually between 30 and 70.
Genetics: siblings of people with RA are 2-4 times more likely to develop RA then GP.
Viral / bacterial infection ?
Moderate to severe periodontal disease.
Smoking.
cause - (Ray got an infection)
The exact cause is Unknown
Research points to combination of genetic and environmental factors:
An infectious insult could trigger RA in genetically susceptible individuals.
Genetics:
RA: AUTOIMMUNE ROLE
STEP 1: PATHOGEN creates abnormal IgG .Possibly a virus or bacteria triggers the formation of an abnormal immunoglobulin (IgG).
STEP 2: Auto-Antibodies (rheumatoid factors - RF) form against this abnormal IgG
STEP 3: RF combines with the abnormal IgG and deposits into tissues. (joints, bld vessels, and pleura)
STEP 4: Inflammatory response results (which causes cartilage, bone, and systemic damage)
STAGES OF RA
1 - 4
RA:CLINICAL MANIFESTATION
Systemic symptoms such as: fatigue, malaise, fever
Joint pain with stiffness and edema
EXTRA-ARTICULAR MANIFESTATION OF RA
Extra-articular involvement is a marker of disease severity and is associated with premature death. Almost all systems could be affected.
EXTRA-ARTICULAR MANIFESTATION OF RA - hands (Ray has reynauds)
Raynaud’s phenomenon
LAB TESTS FOR RA - Serum RF (RF is IG)
No single lab test is conclusive
Serum RF (rheumatoid factor)
Present in 80-85%
Measures unusual antibodies of IgG/IgM
LAB TESTS FOR RA (RA is anti-cop)
Anti-CCP (cyclic citrulinated peptide): is more specific than RA with a sensitivity raging 50-70 % and specificity of 90 %.
This test is also positive in other condition such as TB, SLE (lupus) and chronic lung disease.
TREATMENT OF RA
Goal:
Eliminate or relieve pain
Prevent joint damage
Prevent loss of function
Drug therapy
Physical therapy
Occupational therapy
Patient and family education
DRUG THERAPY for RA (RA drugs missed dmark)
Usually require a combination of meds.
Pain
Anti-inflammatory medication
DMARD’s: Disease Modifying anti-rheumatic drugs (immunosuppress)
In the past pts were maintained on high doses of ASA and NSAIDS for several years until X-rays showed bone erosions and patient’s w/ increased GI Bleeds and stomach ulcers
Now a more aggressive drug approach is used early on to minimize the erosive, destructive process
PHARMACO-THERAPY
ASA and NSAIDS
Corticosteroids : as a bridge therapy
DMARD’s: Disease Modifying Anti-Rheumatic Drugs.
As a class , these drugs depress the overactive immune system.
They are classified as biologic and non-biologic.
PHARMACO-THERAPY : DMARDS
Non-biologic DMARDS: are indirect, non-specific:
biologic DMARDS: are specific in that they interfere with a specific mediator on of the immune system:
DMARDS: Methotrexate - first used as what?
Methotrexate: still the main stay of RA TX
First used as a chemo agent, was FDA approved for RA in 1975.
DMARDS: Methotrexate - toxicity (meth in BLLK)
Toxicity: of pulmonary , hepatic and hematological systems ( bone marrow depression)
Monitoring: CBC, chemistry including liver functions and serum creatinine.
DMARDS: NON-BIOLOGIC Azulfidine - what does it do and combo? (Azul is inflammed)
Azulfidine (Sulfasalazine)
Most common combo with Methotrexate
Suppresses the inflammatory system.
Cash price: 30$ per month
Leflunomide - MOA (no T cells lef)
Inhibits T cell activity
Cost $45/month
36% have a 50% reduction in sx’s
DMARDS: NON-BIOLOGIC -Plaquenil and Chloraquine - what do they do?- (think trump)
Remission-Inducing Agents
Antimalaria drug
Ability to bind and alter DNA modifying effect
DMARDS: NON-BIOLOGIC - REMISSION INDUCING AGENTS - gold salts
REMISSION INDUCING AGENTS
GOLD SALTS
For patients who do not respond to methotrexate.
50% effective
Oral Gold (Ridaura) Side effect= GI
Haven’t been used very much since 1990s
Cost: 1,381
Penicillamine & Minocycline- type of drugs?
Remission Inducing agents
Has antimicrobial and anti-inflammatory effects
ETANERCEPT (etan is a tumor)
Binds to TNF (tumor necrotic factor) and blocks it’s effect in the synovial fluid.
$ 2,700/month
In combination with Methotrexate
39% have a 50% reduction in sx’s
15% have a 70% reduction in sx’s
Rheumatoid Arthritis Treatments continued
INFLIXIMAB (influx of TNF)
INFLIXIMAB
Neutralizes the biologic activity of TNF
Costs: 6,000/month
In combo with Methotrexate:
39% have 50% reduction in sx’s
25% have 70% reduction in sx’s
RA - stage I (sin is the first)
Stage I: Synovitis.
RA - stage II (2 pans)
Stage II: Pannus formation between the synovium and the cartilage
