Rheumatoid Arthritis And Lupus

Question 1

Management of moderate to severe RA?

Answer 1

O Methotrexate (Rheumatrex) immunosuppressive medication do not use with live vaccines!
O biologic agents-etanercept(Enbrel) adalimumab(Humira) Golimumab (Simponi) Certolizumab pegol (Cimzia) infliximab(Remicade)

Question 2

What is Rheumatoid arthritis?

Answer 2

O chronic, progressive, systemic inflammatory autoimmune disease
O Exacerbations and remissions
O Cause unknown-3 theories
O Autoimmune response
O Environmental factors
O Genetic

Question 3

Diagnostics of RA

Answer 3

Laboratory tests 
O Rheumatoid factor- 
O CCP2 Assay- 
O ESR- 
O C-reactive protein- elevated
O ANA- positive
Arthrocentesis- fluid drawn out of joint with needle
X-Rays

Question 4

What is the first choice of meds for RA?

Answer 4

O Disease Modifying Anti-rheumaticDrugs (DMARDs)- First choice
O Hydroxychloroquine (Plaquenil) 
O Sulfasalazine   (Azulfidine)

Question 5

Clinical manifestations of lupus?

Answer 5

O Profound Fatigue 
O Severe joint and muscle aches 
O Butterfly rash over cheeks and nose 
O Extreme photosensitivity
O Weight loss 
O Mouth sores 
O Hair loss 
O Low-grade fever
O Central nervous system (depression)
O Pericarditis (infection of sac that holds heart)
O Pleuritis 
O Atherosclerosis 
O Renal disease (50% of lupus PT’s)

Question 6

Function of meds for RA used to

Answer 6

Relieve or reduce pain 
⮚ Improve daily function 
⮚ Reduce joint inflammation (swelling,
tenderness, limited ROM) 
⮚ Prevent or delay significant joint damage
and deformity 
⮚ Prevent permanent disability 
⮚ Improve quality of life

Question 7

How do we diagnose Lupus?

Answer 7

O Complete history 
O Laboratory tests-
ANA- will be elevated and positive
C-reactive protein- will be positive and elevated 
Anti-Ds DNA-
Elevated BUN

Question 8

Which DMARD is photosensitivity a concern of?

Answer 8

Plaquenil (used for RA as well as Lupus

Question 9

Clinical symptoms/manifestations of RA

Answer 9

Clinical Manifestations
O Morning
stiffness
O Joint pain 
O Swelling 
O Warmth 
O Erythema 
O Lack of
function
O Begins with
small joints
O Deformities 
O Rheumatoid nodules-
more advanced 
O Systemic symptoms

Question 10

Med management of mild RA

Answer 10

• NSAIDS COX-2
• OT/PT
• Glucocorticoids
• DMARDS