RA- Managmment

Question 1

What are the signs and symptoms of RA

Answer 1

Symptoms are gradual and progress slowly
Sx incl
- Malaise, fatigue( +/- muskuloto skeletal pain)
- SYMMETRICAL- pattern( joint ain, stiffness, swelling and redness). NB:Usually manifest on both sides
- Affects- joints of fingers and feet
- Morning stiffness( last longer than 30> minutes9 AROUND 1 HR )
- Morning stiffness, fever, depression

Question 2

What lab result are tested for RA

Answer 2

• ^ ESR
• ^ C Reactive protein (CRP)
• HLA typing
• Changes in joint radio graphs.
• ^ ANA- antinuclear antibodies
• CCP is more specific in diagnosis and more sensitive in the erosion of the disease
• RF factor - positive in 40-60 of patients but it isn’t specific

Question 3

What happens if no treatment is started ?

Answer 3

Patient has decreased quality of life Due to temporary or permanent disability due to joint stiffness.
Mortality rates 2-3 times higher due to extra articulate manifestations.
-Extra articulate manifestations are as a result of long standing inflammation in the body hence the importance to treat RA aggressively
- ie Cardiovascular disease, Ischemic heart disease , Infections, lung disorders, skin disease( Hodgkin(cancer of lymphatic system )
-

Question 4

What are the MAIN goals of starting treatment

Answer 4

*MAINTAIN REMISSION - Symptomatic relief+ normal inflammatory markers+ absence of joint swelling. *

• Maintain joint and muscle function
• Minimise side effects of treatment
• Reduce onset of co morbidly ie depression, Heart disease.
• Protect other organs

Question 5

What are the non pharmacological therapies available for RA

Answer 5

Life style management
- exercise - land and water base exercises- helps cardiovascular health also weight bearing exercises helps bone health
- Diet — eating an anti inflammatory diet- high in healthy fats , low carb, no sugar , increased vegetables

Vaccination - Make sure pt immunisations are up to date due to immune suppression caused by medication
Comp Medicines - Omega 3 fatty acids

Question 6

What are the pharamlogical therapies available.

Answer 6

1. Analgesia.
2. Cortico steroids
3. Synthetic dMARDS
4. Biological dMARDS

Question 7

What are the management considerations for RA with NSAIDs

Answer 7

Treats all acute synovitis in all stages.
- what it does- reduces inflammation, joint swelling and stiffness
- Two choices - selective cox 2 or non selective cox1/2 inhibtiors
- Choice depends on - renal function , other comirbidies( ie cvd, asthma, ALLERGY)
S/E— gi( nausea, diarrhoea) Ulcer
- there is no rational for using more tan 1 NSAID- Just stick to one.
** LOWEST POSSIBLE DOSE for shortest time frame
**Can use NSAID + PARACETAMOL.

Question 8

What are the management considerations with Cortico steroids.

Answer 8

Used in bridging therapy- Where stereo is initiated while the immune modulator(sDMARDS) takes time to kick in.
Used for FLARES up

-Comes in IV, IM, ORAL

-Intra articulate injections- 120mg methyprednisalone Injection
- normally gives 8 weeks relief.
- Following injection 24-48 hrs rest
- Not repeated in same joint > 4x per year
- RISK- osteo necrosis, TEndon rupture

Question 9

What are the management considerations for Synthetic dMARDS

Answer 9

-Sulfasalizine , Hydroxychloriquine ,Methotrexate , Leflunomide

Introduce at the start of Diagnosis- to eradicate inflammation as joint distraction manifest within 2 years

Question 10

What are the management considerations for Biological DMARDS

Answer 10

Reserved for patients who are non responsive to sDMARDS
Often used with methotrexate
Avoid using more than 1 biologic- increased risk of infections
** MONITOR FOR OPPORTUNISTIC INFECTIONS **
** MAKE SURE TO HAVE IMMUNISATION RECORDS UPTO DATE

Question 11

WHAT IS THE TREATMENT ALGORITHIM PT 1

Answer 11

Question 12

PT2

Answer 12