Rheumatolic & Inflammatory Flashcards
Rheumatoid Arthritis
- define
- most common form of
Chronic inflammatory disease of unknown etiology characterized by symmetric polyarthritis
Chronic inflammatory arthritis
Rheumatoid Arthritis
- incidence
- who
Incr from 25-55 years, plateaus until 75, then decr
Females 2-3x more
0.5-1.0% of pop worldwide
Rheumatoid Arthritis
-pathophysiology
—factors
—results
Genetic, environmental, immunologic factors
Dysregulation of immune system and breakdown of self-tolerance
Various autoantibodies produced
Chronic inflammation of synovial tissue and underlying bone/cartilage
Rheumatoid Arthritis -clinical features —presenting symptoms usually result from —common complaints —where it goes first —other manifestations
Inflammation of joints/tendons/bursae
Early morning stiffness that eases with physical activity
Hands and feet
Constitutional - weight loss, fever, fatigue, malaise, depression
Extra-articular may develop in 40% even before onset of arthritis
Incr rates of CVD and osteoporosis
Rheumatoid Arthritis
-diagnosis (4)
Largely clinical Serum Abs (RF, anti-CCP) Synovial analysis (incr WBCs) Joint imaging
Rheumatoid Arthritis
-treatments (4)
NSAIDs - adjunctive (SEs)
Glucocorticoids - rapid control, manage flares, those with inadequate reponse to DMARDs
DMARDs - methotrexate, hydroxychloroquine, sulfasalazine
Biologicals (bio DMARDs) - TNF-alpha inhibtors (infliximab), abatacept, rituximab
Rheumatoid Arthritis
-OD implications
—ocular manifestations
—others
Uveitis, posterior scleritis, dry eye/Sjogrens
Drug interactions, steroids, ability to use hands for eyedrops
Systemic Lupus Erythematosus
- what
- who
Autoimmune disease in which organs and cells throughout the body undergo damage initially mediated by tissue-binding autoantibodies and immune complexes
90% women in child-bearing years
Esp. African descent
Systemic Lupus Erythematosus
-autoantibodies
In most pts are present years before symptoms develop
Systemic Lupus Erythematosus -pathophysiology —factors —genes —environment (4)
Genetic, environment, gender, race, abnormal immune response
Multigenic - if enough present = disease
Environmental stimuli:
- UV light exposure - flares in 70%
- Epstein-Barr virus - SLE = more likely to be infected
- current tobacco smoking incr risk
- moderate alcohol consumption protective
Systemic Lupus Erythematosus -overview, systemic manifestations —onset vs over time —severity —presence of symptoms
1+ involved at onset, additional manifestations over time
Varies from mild/intermittent to severe/fulminant (rapid)
-usually gradual/not fulminant
With tx, 85% have continuing flares annually (permanent remissions are rare) Systemic symptoms (fatigue, myalgias/arthralgias) are present most of the time
Systemic Lupus Erythematosus -organ-targetted manifestations —muscoloskeletal —cutaneous —renal —nervous system
Musculoskeletal: intermittent polyarthritis, esp hands, knees, wrists
Cutaneous:
- discoid (DLE) is most common chronic lesion
- photosensitivity (butterfly/malar rash) most common acute lesion
Renal: nephritis usually most serious manifestation
Nervous: cognitive/mood disorders in ~50%
Systemic Lupus Erythematosus
-diagnosis
Clinical findings AND autoantibodies
- no stand-alone test/finding
- ANA is best screening
Systemic Lupus Erythematosus -mangement —aim/goal —conservative therapy —aggressive therapy (life-threatening manifestations)
Low-level disease activity - achieved for 30-50%
Analgesics and antimalarials (NSAIDs and hydroxychloroquine)
Systemic glucocorticoids
Systemic Lupus Erythematosus -OD implications —eye-specific —potentially blinding —medications
Sjogrens, non-specific conjunctivitis
Retinal vasculitis, optic neuritis
-aggressive immunosuppression, high-dose steroids
Plaquenil toxicity (more so with RA) Long-term steroids
