Rheumatoid Arthritis Flashcards
Key points:
Highly ??? condition
??? symmetrical arthritis
Correlates with ??? and ???
Correlates with high ??? and low ???
Will lead to ??? and ??? erosion if not treated early
Early tx with ??? is essential for reducing progression
Very few patients reach remission without ???
- Highly inflammatory condition
- Polyarticular symmetrical arthritis
- Correlates with family history of RA and autoimmune disease
- Correlates with high estrogen and low testosterone
- Will lead to cartilage and bone erosion if not treated early
- Early treatment with DMARDs is essential for reducing progression
- Very few patients reach remission without DMARDs
Clinical Features:
- Polyarticular arthritis with ??? onset
- Pain and stiffness in the ??? with ???
- Generally affects the ??? and ??? joints of the fingers.
Clinical Features:
•Polyarticular arthritis with gradual onset
•Pain and stiffness (especially in the morning) with swelling
•Generally affects the MCP and PIP joints of the fingers.
Clinical Features:
- Extraarticular involvement: 3???
- Joint involvement is generally symmetrical but can be less apparent in ???
- Extraarticular involvement: general aching, stiffness, fatigue.
- Joint involvement is generally symmetrical but can be less apparent in early disease (33% of patients with RA have only 1-2 joints involved initially).
Clinical Features:
- PE: 3???
- Chronic RA: 3???
- PE: reduced grip strength, swollen joints or hands, reduces ROM
- Chronic RA: ulnar deviation, Boutonniere deformities, swan neck deformities.
Epidemiology:
•Women are affected ??? more often than men
•Risk decreases during ???
•90% of women with RA flare w/in ??? months postpartum.
•??? strongly increases risk
•Higher in those with other ??? diseases
•Higher in those with a first degree relative with RA or another autoimmune condition
Epidemiology:
•Women are affected 2-3x more often than men
•Risk decreases during pregnancy
•90% of women with RA flare within 3 months postpartum.
•Cigarette smoking strongly increases risk
•Higher in those with other autoimmune diseases
•Higher in those with a first degree relative with RA or another autoimmune condition
Diagnostic Testing: •Joint aspiration – elevated ??? •CBC – 3??? •Autoantibodies – 3??? •ESR and CRP – often ??? in active disease •Radiography – joint space 2??? •Generally normal in ???disease •MRI – more sensitive for identifying ??? in ??? disease •Ultrasound – sensitive for ???
Diagnostic Testing:
•Joint aspiration – elevated leukocytes
•CBC – anemia, thrombocytosis, mild leukocytosis
•Autoantibodies – RF, Anti-CCP often elevated (seropositive RA)
•ESR and CRP – often elevated in active disease
•Radiography – joint space narrowing and bony erosions
•Generally normal in early disease
•MRI – more sensitive for identifying bony erosions in early disease
•Ultrasound – sensitive for estimating the degree of inflammation
Diagnosis:
2010 ACR/EULAR criteria (6 of the following 10 points):
•2 – 10 large joints (shoulders, elbows, hips, knees, ankles): ??? point
•1 – 3 small joints (MCP, PIP, MTP, thumb, wrists): ??? points
•4 – 10 small joints: ??? points
•Greater than 10 jts (including at least 1 small joint): ??? pts
•Low positive (RF/anti-CCP): ??? points
•High positive (RF/anti-CCP): ??? points
•Elevated ESR/CRP: ??? point
•Symptom duration of at least 6 weeks: ??? point
Diagnosis:
2010 ACR/EULAR criteria (6 of the following 10 points):
•2 – 10 large joints (shoulders, elbows, hips, knees, ankles): 1 point
•1 – 3 small joints (MCP, PIP, MTP, thumb, wrists): 2 points
•4 – 10 small joints: 3 points
•Greater than 10 joints (including at least 1 small joint): 5 points
•Low positive (RF/anti-CCP): 2 points
•High positive (RF/anti-CCP): 3 points
•Elevated ESR/CRP: 1 point
•Symptom duration of at least 6 weeks: 1 point
Disease Progression:
•Remission is ??? without DMARD intervention
•Remission does not mean a ??? in erosive changes
•Pts should be monitored on a regular basis for (3)??? every few months.
Disease Progression:
•Remission is very rare without DMARD intervention
•Remission does not mean a reduction in erosive changes
•Patients should be monitored on a regular basis for ESR/CRP, drug toxicity and overall disease progression every few months.
Conventional Medications:
Early treatment with ??? is essential to halting disease progression
- Mildly active RA: 2
- Moderately - severely active RA: 2
- Chronic resistant RA: 2
Conventional Medications:
Early treatment with DMARDs is essential to halting disease progression
- Mildly active RA:
* NSAID – for rapid symptom relief
* Hydroxychloroquine or sulfasalazine - Moderately - severely active RA:
* NSAID or glucocorticoid – for symptom relief
* Methotrexate - Chronic resistant RA:
* Combination biologic with non-biologic DMARDs (Methotrexate with TNF inhibitor or SSZ or HCQ)
* Switch to different DMARD (leflunomide)
Dietary Modifications:
•Types of DIET??? 2
•Eliminate which food allergens??? (4)
- Lean sources of ???
- Avoid 2 THINGS
•Reduction in inflammatory foods: (3)
Dietary Modifications:
“VEGAN DIET” & Plant-based diet
Eliminate food allergens •Gluten •Dairy •Eggs •Nightshades
- Lean sources of protein
- Avoid alcohol/smoking
Reduction in inflammatory foods:
•Sugar
•Red meats
•Dairy
Dysbiosis:
Herbal anti-microbial agents: 4
Dysbiosis:
Herbal anti-microbial agents:
- Berberine – 500mg BID
- Oregano Oil – 300mg BID
- St. John’s Wort – 400 – 600mg BID - TID
- Include probiotics
Immune Modulation: 7
- Vitamin D – 2,000 – 4,000IU21
- Vitamin C – 1,000 – 2,000mg per day
- EFA’s – 3,000 – 6,000mg per day.20
- Has been shown to improve symptoms in those with RA and reduce risk of CVD.
- Selenium – 400 – 600mcg/day
- Zinc – 60mg per day
- Vitamin E – 400IU/day
- Bromelain: 250 – 750mg TID
Hormones: Common hormonal imbalances: •??? prolactin •??? estrogen •??? insulin •??? DHEA •??? cortisol (LOW VS HIGH)
- ??? testosterone
- Thyroid hormone
Hormones: Common hormonal imbalances: •Elevated prolactin •Elevated estrogen •Elevated insulin •Reduced DHEA
•Reduced cortisol-> Most occur after stressful event or long time stress.
(High-suppresses immune system, low= flares.)
- Reduced testosterone
- Thyroid hormone
Botanical Medicine: 4
Botanical Medicine:
•Cucumin: 1 – 1.5g/day in divided doses17, 23
•Ginger: 8 – 10g dried or extracts/day22
•Valerian root: 1.5 – 3g/day
•Uncaria tomentosa (Cat’s claw) – 20mg TID
