RA Case Studies Flashcards
What investigations are involved with RA?
Rheumatoid factor (RF)
Anti-cyclic-citrullinated peptide (CCP)
FBC
U+Es
LFTs = liver function tests
ESR/CRP = check for infection
Why do investigations?
Need to know what the normal is for person before you put them on medication
What 4 things are looked at for RA diagnosis?
Tender/Swollen joints
Symptom duration
Serology
Acute phase reactants
SCORE >6 = RA
Describe tender/swollen joint RA diagnosis
0 = 1 joint
1 = 2-10 large joints
2 = 2-3 small joints
3 = 4-10 small joints
5 = >10 small/large joints
Describe symptom duration RA diagnosis
0 = < 6 weeks
1 = > 6 weeks
Describe serology RA diagnosis
0 = negative RF + ACPA
2 = low positive RF + ACPA
3 = high positive RF + ACPA
Describe acute phase reactants
0 = normal CRP/ESR
1 = elevated CRP/ESR
Why do caution NSAIDs with Methotrexate?
Renally cleared, narrow therapeutic window = toxicity = bone marrow suppression = stomatitis
NSAID decrease blood flow through kidneys = methotrexate accumulate = toxicity
What does methotrexate toxicity look like?
Bone marrow suppression
What is the choice NSAID for RA?
Naproxen = decreased cardiovascular risk
What must you also take if you’re taking methotrexate?
Folic acid
Can methotrexate + folic acid be taken on the same day?
NO
What PPI should you be on?
Lansoprazole
What are the side effects of parentals?
Pain at site of injection
Thinning of skin
What is 1st line treatment?
Oral methotrexate, Leflunomide + Sulfasalazine
OR Hydroxychloroquine for palindromic
What should be offered with use of NSAID?
PPI
What also do you need to think about when managing pain?
Mental health
= SSRI antidepressants
What is osteoarthritis?
Related to aging process
= minor damage to joint surfaces
= cytokines
= damage to cartilage
What are the side effects of glucocorticoids?
Weight gain
Diabetes
Cataracts
Osteoporosis/osteoarthritis
Increased risk of infection
