Rheumatoid arthritis Flashcards
Describe the epidemiology of rheumatoid arthritis
more common in women
peak onset around 50 yrs
highly associated with smoking
List the diagnostic criteria for RA
- number and distribution of joints (more points for more joints and small joints)
- serum markers RF and CCP
- ESR/ CRP
- duration > 6 weeks
Sore > 6/10= RA
List risk factors for RA
HLA-DR association
smoking
Describe the histologic features of RA
synovial inflammation forming a pannus rich with inflammatory cells
vascular proliferation
matrix metaloproteinases eroding bone and cartilage–> marginal erosions
____ erosions are characteristic of RA
Marginal
What joints are most commonly affected by RA?
PIP, MCP, wrist, MTPs
rarely hips, DIP, lumbar spine
List the extra-articular manifestations of RA?
rheumatoid nodules, nail fold infarcts, ulcers due to vasculitis, pleurisy, interstitial lung disease, pericarditis, nodules on heart valves, aortitis, accelerated CV disease, peripheral neuropathy
What is Felty’s syndrome
neutropenia + splenomegaly
What antibody tests are most useful to diagnose RA?
RF (but not specific for RA)
CCP is both sensitive and specific for RA
List major goals of RA treatment
- reduce joint pain and inflammation to improve functional status and quality of life,
- prevent bone/cartilage damage including joint erosions
- control systemic inflammation to limit mortality
List treatment options for FA
NSAIDs
DMARDs: methotrexate, sulfasalazine, hydroxychloroquine, leflunomide
Biologic agents: TNF-a agents, others
______ can be given orally or by intra-articular injection for acute relief from RA but are not used for long term therapy
corticosteroids
________ are used in patients who have aggressive arthritis or who have failed one or more DMARD
Biologic agents
________ works by subtle immunomodulation without significant immunosuppressive risks
hydroxychloroquine
What is the mechanism of hydroxychloroquine?
stabilizes lysosomal membranes, inhibits DNA polymerase, decreases fibronectin, platelet aggregation, histamine production, and IL-1-induced cartilage degradation/cytokine production.
What is the mechanism of action of methotrexate?
Inhibits dihydrofolate reductase, thus decreasing cellular turnover in rapidly proliferating cells
What are side effects of methotrexate?
aphthous ulcers, stomatitis, alopecia, GI upset, macrocytic anemia, infection risk
______ is a major teratogen and is contraindicated in pregnancy
Methotrexate
______ is analagous to methotrexate
Leflunomid- inhibits dihydroorotate dehydrogenase essential for pyrimidine syntehsis, anti-proliferative effects
_____ is given when patients on leflunomide develop infection, due to the very long half life of the drug
cholestyramine
What is the mechanism of action of sulfasalazine
antibacterial and anti-inflammatory
What are the components of triple therapy?
Methotrexate + Sulfasalazine + Hydroxychloroquine
What steps are necessary before initiating a TNF a agent?
TB test, chest X ray
TNF agents block either by ________ or by ______
monoclonal antibodies or receptor blockade
