RA & lupus

Question 1

RA and lupus erythematous are inflammatory conditions that result in

Answer 1

Pain

Limitation of movement

Destruction or erosion of
Joints, muscles, or ligaments

Question 2

what is the origin of RA and Systemic Lupus Erythematous

Answer 2

Autoimmune

Question 3

is RA and lupus erythematous systemic or local

Answer 3

systemic

Question 4

what is RA

Answer 4

A systemic, autoimmune disease that is a Type III hypersensitivity disorder

Question 5

RA is an inflammatory disease of what

Answer 5

synovium

Question 6

Environmental and genetic factors of RA

Answer 6

Genetic link + triggering event
Inappropriate immune

response to a joint injury??

Question 7

Risk factors for RA (Age,gender, tobacco use?)

Answer 7

40-60s
women
YES tobacco users

Question 8

Patho of RA

Answer 8

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

Question 9

what is RA:Progressive disease

Answer 9

Intensifying inflammatory response
Cartilage is destroyed by osteoclasts
Pannus develops

Question 10

what does pannus cause

Answer 10

bone erosion
bone cysts
fissure development

Question 11

RA clinical manifestations for EVENTUAL JOINT MANIFESTATIONS

Answer 11

Symmetrical

Pain, stiffness, motion limitation

Inflammation: heat, swelling, tenderness

Question 12

RA clinical manifestations for ADVANCED DISEASE

Answer 12

deformity and disability

joint subluxation

Question 13

RA systemic involvement

Answer 13

Fatigue, malaise

Potentially affect any/all body systems (more severe form)

Most common

• Rheumatoid Nodules
• Sjögren’s syndrome (next slides)

Question 14

What are rheumatoid nodules

Answer 14

Immune-mediated granulomas

Develop around inflamed joints and in lungs

Subcutaneous, firm

Sometimes painful

Question 15

Goals of pharmacotherapy for RA (2)

Answer 15

1. Relieve pain and swelling

2. Slow or stop disease progression

Question 16

Long-term drug therapy for RA

Answer 16

REQUIRES PATIENT ADHERENCE

NSAIDS: immediate relief

Glucocorticoids: short term only

Disease-modifying anti-rheumatic drugs:
(DMARDS) slow the disease process

Question 17

What is systemic lupus erythematous

Answer 17

Autoimmune inflammatory disease:

Multiple organ systems
Acute flare-ups
Unpredictable

Question 18

systemic lupus erythematous is an autoimmune attack against what

Answer 18

body’s own DNA

Question 19

2 major forms of systmeic lupus erythematous

Answer 19

discoid

systemic

Question 20

systemic lupus Patho

Answer 20

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

Question 21

SLE manifestations (7)

Answer 21

Extreme fatigue

Photosensitivity

Butterfly rash

Fever

Weight changes

Unusual hair loss

Edema

Question 22

SLE CNS manifestions

Answer 22

HA

dizzy

seizure

stroke

Question 23

SLE lungs manifestations

Answer 23

pleuritis

pleural effusions

Question 24

SLE heart manifestations

Answer 24

myocarditis

endocarditis

Question 25

SLE Kidneys manifestations

Answer 25

nephritis

Question 26

SLE blood vessels manifestations

Answer 26

Vasculitis

Question 27

SLE blood manifestations

Answer 27

anemia leukopenia thrombocytopenia blood clots

Question 28

SLE joint manifestations

Answer 28

Arthritis

Question 29

What is a flare

Answer 29

acute exacerbation of symptoms

Question 30

Warning signs of a flare

Answer 30

fatigue pain H/A

Question 31

What is the prevention of flares

Answer 31

recognize warning signs and avoid triggers Sunlight exposure Infection Abruptly stopping a medication Stress

Question 32

Flares clinical course

Answer 32

exacerbations and remissions

Question 33

what is Sjogren Syndrome

Answer 33

Autoimmune destruction of any moisture-producing gland Enlarged glands with decreased functioning

Question 34

DMARDs drug name

Answer 34

Methotrexate hydroxychloroquine

Question 35

class of methotrexate

Answer 35

Antineoplastic (folic-acid antimetabolite), antirheumatic

Question 36

MOA of methotrexate

Answer 36

immunosuppressive

Question 37

How is methotrexate administered

Answer 37

weekly via PO or SQ/IV route

Question 38

S/E of methotrexate

Answer 38

GI Bone marrow suppression Shortened life expectancy

Question 39

nursing care for Methotrexate

Answer 39

``` 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 ```

Question 40

class of hydroxycholorquine

Answer 40

Antimalarial, antirheumatic agent

Question 41

MOA of hydroxychloroquine

Answer 41

Unknown, antiinflammatory properties

Question 42

drug effects of hydroxychloroquine

Answer 42

Slow progression of RA when used with another DMARD

Question 43

Therapeutic Uses | hydroxychloroquine

Answer 43

Used alone or in combination with Methotrexate for early/mild RA

Question 44

Side/Adverse Effects | hydroxychloroquine

Answer 44

Rare: Retinopathy

Question 45

similarities bewteen RA and SLE

Answer 45

Autoimmune diseases Systemic inflammation Multiple body system Pharmacotherapy

Question 46

Major difference between RA and SLE

Answer 46

``` RA = focus on joints (sometimes organs) SLE = multisystem (sometimes joints) ```