Rheumatoid Arthritis Flashcards
Describe RA.
Symmetrical joint involvement. Rheumatoid nodules, vasculitis, ocular inflammation, cardiopulmonary, splenomegaly
What are the risk factors for RA?
Genetics, increasing age, females, positive rheumatoid factor, smoking
What is the pathophysiology of RA?
Autoimmune disorder that attacks the synovial and connective tissues.
What is pannus?
Chronic inflammation results in proliferation of the synovial tissue.
Pannus invades cartilage and bone surface resulting in bone erosion
What are the prodromal symptoms of RA?
weakness, low grade fever, loss of appetite, joint pain, fatigue
What are the inflammatory markers of RA?
ESR, CRP, RF, anti-CCP
Describe the ACR/EULAR criteria.
Help to predict the severity of the disease. score 6 out 10 classifies as definite RA.
What is the criteria for complete remission?
Absence of
Symptoms of inflammation, morning stiffness, fatigue, synovitis, progression, elevation of ESR, CRP
What are the predictors of a poor response to treatment?
Functional limitations, Positive RF, ACPA antibodies, radiographic evidence of bony erosions
What immunizations do RA patients need to get?
Annual Flu, pneumococcal prior (5yrs)
When are NSAIDS, COX2 inhibitors used?
Early relief or adjunct to DMARD
When are corticosteroids used?
Adjunct until DMARD begin working.
When should DMARD treatment begin?
Within 3 months of patient with established diagnosis of RA.
What is the standard DMARD?
Methotrexate (Rheumatrex)
When taking Rheumatrex what should be also given?
Folic acid supplements
What are the monitoring parameters for Methotrexate?
CBC,LFT monthly x 6 months
What drug inhibits pyrimidine synthesis?
Leflunomide (Arava)
What drug is an antimalarial that inhibits t-cells and b-cells?
Hydroxychloroquine (Plaquenil)
What drug is associated with retinal toxicity?
Hydroxychloroquine (Plaquenil)
What drug suppresses pro-inflammatory cytokines, it is a prodrug?
sulfasalazine (Azulfidine)
What drug should be avoided with a sulfa allergy?
Sulfasalazine (Azulfidine)
What drug can be used for pregnant patients?
Sulfasalazine (azulfidine)
Which drug is an tetracycline antibiotic used for RA?
Minocycline
What drug inhibits phagocytosis and lysosomal enzyme activity?
Gold, delayed onset of 3-6months
What drug is a purine analog and takes 1-3months before onset?
Azathioprine (Imuran)
This drug is associated with nephrotoxicity and has a delayed onset of 1-3months.
Cyclosporine
What risk is assoicated with the biologic response modifiers?
Risk of infections,
TB screening
Which TNF-antagonists can be administered at home?
Etanercept (Enbrel)
Adalimumab (humira)
Golimumab (simponi)
Certolizumab (Cimzia)
Which TNF-antagonist is administered in the physician’s office?
Infliximab (Remicade)
Which drug is an IL-1 antagonist?
Anakinra (Kineret)
Patient administered
What drug is an anti-CD20?
Rituximab (Rotuxan)
Used with methotrexate
Infusion
What drug is a selective co-stimulation modulator?
Abatacept (Orencia)
Physician’s office
What drug binds to IL-6 receptor?
tocilizumab (Actemra)
Infusion
What drug is a janus kinase inhibitor?
Tofacitinib (Xeljanz)
