RHEUMATOID ARTHRITIS Flashcards
What is rheumatoid arthritis?
- Chronic inflammatory disease affecting joint synovial membrane
- Degeneration of cartilage and joints due to lymphocytes
RF
- FMHx
- Female
- Smoking
Factors which aggravate RA?
Pain and stiffness worsens with rest, inactivity and heat in the joints
Symptoms of RA
- pain and stiffness of joints
- swelling of joints
- deformity of the fingers and thumbs
- malaise, fatigue, fever, and weight loss
What are the extra-articular symptoms of RA?
- Sjogren’s syndrome (dry mouth or dry eyes)
- Vasculitis (inflammation of blood vessels
- Neuropathy (damage to nerves)
- Subcutaneous nodules
- Lymphadenopathy
Diagnosis
- American Rheumatism Association criteria
- List of criteria e.g. morning stiffness, number of joints affected etc. - Biochemical investigations for markers that confirm an inflammatory condition:
- ESR
- CRP
- Rheumatoid factor (RF) - Imaging
- X-ray
Non-drug treatment
- physiotherapy
- strengthens joints and helps reduce pain - Occupational therapy
Drug treatment
- NSAIDs and analgesia
- Disease-modifying anti-rheumatic drugs (DMARDs)
- Corticosteroids
- Biologics (Cytokine inhibitors
NSAIDs for RA
NSAIDs can be used in pain relief - withdrawn when response to DMARDs is enough
OTC NSAIDs
Can’t give NSAID OTC to pt with RA
However, if prescribed by Dr is ok
What are the two
types of corticosteroid treatment for RA?
- Systemic
Or - Local
What is involved in systemic corticosteroid
treatment and in what situation would you give it to them?
- Given as either, IM, IV or Oral
- usually used during acute flare-ups or when bridging treatment between DMARDS
Why is systemic treatment not given for the long term in RA?
- Because of the risks of osteoporosis
- Also, when patients stop, relapse occurs
- Systemic CS are only better for short-term use during initiation of DMARDS (which are used as long-term treatment)
What is involved in local corticosteroid treatment?
- Intra-articular injection
- Used to reduce inflammation and pain
- Injected directly into the joint e.g. Knee
- Examples of corticosteroids used are: Dexamethasone, Hydrocortisone, Methhylprednisolone, Prednisolone, triamcinolone
How do DMARDs work and how many types are there?
- They alter the underlying disease rather than treat symptoms
- There are two types:
1. Conventional DMARDs
And
2. Biologic DMARDs (Cytokine inhibitors)
How long does it take for DMARDs to work?
- 2 - 6 months
List the conventional DMARDs used in RA
- Methotrexate
- Ciclosporin
- Sulfasalazine
- Hydroxychloroquine
- Azathioprine
- Cyclophosphamide
- Leflunomide
- Penicillamine
First line treatment
(DMARDs):
First Line → Methotrexate, leflunomide, or sulfasalazine (hydroxychloroquine in mild)
Second Line → MoAbs: TNF alpha inhibitor adalimumab, etanercept, infliximab, tocilizumab, baricitinib
Bridge with corticosteroids when rapid suppression is needed
Which DMARD is usually given in RA?
- Methotrexate, Sulfasalazine or Hydroxychloroquine
- A combination of TWO DMARDs (e.g. methotrexate with another DMARD) and short-term corticosteroid is usually given in newly diagnosed (ideally within 3 months)
- If contraindicated to the two combination drugs, then give a single drug only
General SE of DMARDs
Bone marrow suppression, Increased risk of infection
Methotrexate: hepatotoxicity and renal impairment
Ciclosporin: HT
hydroxychloroquine SE
- Retinal toxicity: report any changes in vision
- SE: abdominal pain, DNV
- MHRA warning: Increased risk of CV events when hydroxychloroquine given with Macrolide Abx
DMARD monitoring
- FBC
- Renal
- Hepatic
- ESR, CRP and Rheumatoid factor
- Tto see how the patient is responding
What are the two types of Biologic
DMARDS (cytokine inhibitors)?
- Anti-TNF therapies
And - Non- Anti-TNF therapies
Which Biologic is an Anti-TNF?
- Adalimumab
- Certolizumab
- Etanercept
- Golimumab
- Infliximab
All are administered parentally
