Rheumatoid Arthritis FINAL Flashcards
Altered IMMUNITY that occurs when transformed antibodies (rheumatoid factors) cause inflammation.
Chronic, progressive, systemic inflammatory autoimmune disease that destroys synovial joints and other body tissues with remission and exacerbations.
Rheumatoid Arthritis
What body systems are affected by RA?
Cardiovascular, lung, eyes, and skin
Risk factors for RA?
- Onset age 35-45y
- Female (3:1)
What are the causes of RA?
Autoimmune, genetic basis.
Emotional stress triggers exacerbations.
Environmental factors.
S/Sx of Rheumatoid Arthritis
-INFLAMMATORY
-Bilateral, symmetric, multiple joints
-Usually upper extremities are affected first
-Distal interphalangeal joints of hands are spared
-Systemic
-Prolonged morning stiffness
-Pleuritic pain
-Anorexia/weight loss
-Fatigue, paresthesias (tingling, pins and needles)
-Joint pain, swelling and deformities
Labs for RA
- Anti-CCP antibody
- Rheumatoid factor antibody elevated
- ESR/hsCRP elevated
- ANA titer antibody elevated
- Elevated WBCs
What is an arthrocentesis?
a procedure to aspirate a
sample of the synovial fluid to relieve pressure
and analyze the fluid for inflammatory cells and
immune complexes
Meds for RA
-NSAIDs for short term use
-COX-2 enzyme blockers
-corticosteroids
-DMARDs
-BRMs
-Glucocorticoids
What drugs are used to slow the progression of RA?
Disease modifying anti-rheumatic drugs (DMARDs)
o Methotrexate - immunosuppressive medication, in a low, once-a-week dose (generally 25 mg or less orally) is the mainstay of therapy for RA because it is effective and relatively inexpensive.
o Leflunomode (Arava)
What is the benefit in giving glucocorticoids (Prednisone (Deltasone))?
given for their fast-acting anti-inflammatory and immunosuppressive effects
Most Biological Response Modifiers (BRMs) neutralize the biologic activity of tumor necrosis factor–alpha (TNFA) by inhibiting its binding with TNF receptors.
Common examples include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), and certolizumab (Cimzia).
What pt teaching should be provided for these meds?
Teach patients to avoid crowds and people with infections because serious infections, especially respiratory infections, can lead to hospitalization or cause death.
RA Procedures
- Plasmapheresis/plasma exchange to remove the
antibodies causing the disease - Total joint arthroscopy
- Synovectomy
Removal of the inflamed synovium
Synovectomy
Complications of RA
-Chronic inflammation
-Decreased mobility related to deformities, muscle atrophy and fatigue
-Decreased self-esteem because of deformities
-Sjögren’sn Syndrome
-Vasculitis (organ ischemia)
-Felty Syndrome
What is Sjögren’s Syndrome?
TRIAD, dry eyes, mouth and vagina. Caused by obstruction of secretory ducts and glands
