Rheumatoid Arthritis Flashcards
Arthritic Conditions
>100 conditions Common include: Systemic lupus erythematosus (SLE) Gout Scleroderma Rheumatoid arthritis (RA) Fibromyalgia Juvenile rheumatoid arthritis (JRA) Bursitis tendonitis Osteoarthritis Post-traumatic arthritis
Rheumatoid Arthritis
chronic inflammatory joint condition with intermittent exacerbations (flare-up)
Common to 20-50 years old but not limited to adults also seen in children (JRA)
3 times more common in women than men
Untreated, almost 1/3 of people with it will become disabled in 2-3 yrs
Most debilitating arthritic disorder→ stiffness→ joint pain→ deformities
RA Clinical Presentation
clinical diagnosis primarily
pain & stiffness/restrictions in multiple joints over a period of weeks to months
Bilateral swelling and redness, with joint tenderness, and low grade fever possible
Prodromal symptoms such as anorexia, weakness, or fatigue can occur symptoms predominate after sleeping
Joints most commonly affected are the IP & MCP joints & wrists
Starts at periphery and moves centrally
RA Etiology
Disease of the immune system without clarity of cause & understanding
Synovium becomes inflamed → white blood cell moving into the synovium releasing proteins → fluid thickening → destruction of synovial fluid and joint
Genetic predisposition as well as environmental links (viruses & bacterium)
RA Risk Factors
Female Familial Silicate exposure (silicone) Older age Smoking
RA Dx
A clinical diagnosis should differentiated from a number of other disorders e.g. infection, connective tissue (SLE) & endocrine diseases, and other symptomatic-like disorders
American Rheumatism Association Criteria- can be used to assist in diagnosis process- maybe difficult if it is early in the process
Blood tests such as CBC, ANA, RF, CRP/ESR may or may not be helpful for diagnosis but may be helpful to measure treatment response
X-ray of joint may not be helpful but may assist in following disease progression
Renal and liver function studies may assist in medication choices
RA Tx
Remember RA pts are ALWAYS in pain. PCP role to control pain
Pharmacologic- NSAIDs or Cox-2 for pain control as well as analgesics
Disease modify anti-rheumatic drugs (DMARDs) are initiated quickly to slow joint damage (oral & intra-articular steroids)
Gold base compounds, Methotrexate, biologic response modifiers inhibit cytokines (Humira, Remicade, Enbrel)
Observe for depression secondary to debilitating chronicity of disease (Cymbalta, Citalopram, Zoloft)
RA Non-Pharm Tx
Dietary supplementation of essential fatty acids Exercise Physical therapy Splinting Weight management Heat/Cold application Good ergonomics No over exertion Spa treatments: massage, hot tubs Acupuncture Herbal medications (Some patients improve with glucosamine)
