RA & lupus Flashcards
RA and lupus erythematous are inflammatory conditions that result in
Pain
Limitation of movement
Destruction or erosion of
Joints, muscles, or ligaments
what is the origin of RA and Systemic Lupus Erythematous
Autoimmune
is RA and lupus erythematous systemic or local
systemic
what is RA
A systemic, autoimmune disease that is a Type III hypersensitivity disorder
RA is an inflammatory disease of what
synovium
Environmental and genetic factors of RA
Genetic link + triggering event
Inappropriate immune
response to a joint injury??
Risk factors for RA (Age,gender, tobacco use?)
40-60s
women
YES tobacco users
Patho of RA
Autoimmune attack against the synovial tissue
Immune cells are activated
Lymphocytes
Macrophages
Produce rheumatoid factor (RF):
Auto-Antibody against the body’s own antibody– IgG
Formation of immune complexes and activates complement
what is RA:Progressive disease
Intensifying inflammatory response
Cartilage is destroyed by osteoclasts
Pannus develops
what does pannus cause
bone erosion
bone cysts
fissure development
RA clinical manifestations for EVENTUAL JOINT MANIFESTATIONS
Symmetrical
Pain, stiffness, motion limitation
Inflammation: heat, swelling, tenderness
RA clinical manifestations for ADVANCED DISEASE
deformity and disability
joint subluxation
RA systemic involvement
Fatigue, malaise
Potentially affect any/all body systems (more severe form)
Most common
- Rheumatoid Nodules
- Sjögren’s syndrome (next slides)
What are rheumatoid nodules
Immune-mediated granulomas
Develop around inflamed joints and in lungs
Subcutaneous, firm
Sometimes painful
Goals of pharmacotherapy for RA (2)
- Relieve pain and swelling
2. Slow or stop disease progression
Long-term drug therapy for RA
REQUIRES PATIENT ADHERENCE
NSAIDS: immediate relief
Glucocorticoids: short term only
Disease-modifying anti-rheumatic drugs:
(DMARDS) slow the disease process
What is systemic lupus erythematous
Autoimmune inflammatory disease:
Multiple organ systems
Acute flare-ups
Unpredictable
systemic lupus erythematous is an autoimmune attack against what
body’s own DNA
2 major forms of systmeic lupus erythematous
discoid
systemic
systemic lupus Patho
B-lymphocytes are hyperactive and produce autoantibodies
ANA: antinuclear antibody
Activated against DNA
Formation of: Immune complexes
Can impact all major organ systems!
Inflammatory response destroys tissue
SLE manifestations (7)
Extreme fatigue
Photosensitivity
Butterfly rash
Fever
Weight changes
Unusual hair loss
Edema
SLE CNS manifestions
HA
dizzy
seizure
stroke
SLE lungs manifestations
pleuritis
pleural effusions
SLE heart manifestations
myocarditis
endocarditis
SLE Kidneys manifestations
nephritis
SLE blood vessels manifestations
Vasculitis
SLE blood manifestations
anemia
leukopenia
thrombocytopenia
blood clots
SLE joint manifestations
Arthritis
What is a flare
acute exacerbation of symptoms
Warning signs of a flare
fatigue
pain
H/A
What is the prevention of flares
recognize warning signs and avoid triggers
Sunlight exposure
Infection
Abruptly stopping a medication
Stress
Flares clinical course
exacerbations and remissions
what is Sjogren Syndrome
Autoimmune destruction of any moisture-producing gland
Enlarged glands with decreased functioning
DMARDs drug name
Methotrexate
hydroxychloroquine
class of methotrexate
Antineoplastic (folic-acid antimetabolite), antirheumatic
MOA of methotrexate
immunosuppressive
How is methotrexate administered
weekly via PO or SQ/IV route
S/E of methotrexate
GI
Bone marrow suppression
Shortened life expectancy
nursing care for Methotrexate
Number of FDA Black Box Warnings: 11 Folic acid supplementation is necessary Absolutely no alcohol Absolutely no administration to a pregnant female Contact HCP if develop: Signs of infection
class of hydroxycholorquine
Antimalarial, antirheumatic agent
MOA of hydroxychloroquine
Unknown, antiinflammatory properties
drug effects of hydroxychloroquine
Slow progression of RA when used with another DMARD
Therapeutic Uses
hydroxychloroquine
Used alone or in combination with Methotrexate for early/mild RA
Side/Adverse Effects
hydroxychloroquine
Rare: Retinopathy
similarities bewteen RA and SLE
Autoimmune diseases
Systemic inflammation
Multiple body system
Pharmacotherapy
Major difference between RA and SLE
RA = focus on joints (sometimes organs) SLE = multisystem (sometimes joints)
