Week 10 - Rheumatoid Arthritis Flashcards
what is rheumatoid arthritis
- chronic, systemic autoimmune disease
- characterized by inflammation of CT in synovial joints
what are risk factors of RA (6)
- can occur at any age, but more common in 60+
- female
- genetic
- smoking
- obesity
- stress
what types of stress might contribute to RA (5)
- recent infection
- surgery
- childbirth
- emotional upset
- oevrwork
what is the cause of RA (2)
- unknown
- genetic factors (most)
describe the genetic component of RA
- most people w RA have a circulating antibody called “rheumatoid factor”
- RF binds to other antibodies (IgG) and can form immune complexes which become trapped in the joints & removed by the inflammatory response
what is RA cause by RF called
- seropositive arthritis
what 4 things does the inflammatory response during RA lead to
- enzymatic breakdown of cartilage & subchondrial bone
- synovial angiogenesis
- synovial cell proliferation
- pannus formation
what is synovial angiogenesis
- new blood vessels growing into the synovium
what is pannus formation
- abnormal tissue growth in the joints
what causes pannus formation
- the synovial angiogenesis & proliferation makes the blood thick, rough, and irregular = pannus formation
what symptoms does RA begin with (4)
generalized symptoms
- fever
- fatigue
- anorexia
- weight loss
what happens as the disease progresses regarding symptoms
- they become more localized to joints
what are the acute symptoms of RA that are localized to the joints (4)
- bilateral inflammation
- stiffness
- pain/aching
- limited ROM
what are signs of inflammation during RA (4)
- redness
- heat
- swelling
- tenderness
what makes the pain worse in RA
- activity
where does RA commonly effect (5)
- proximal interphalangeal joint (PIP) & metocarpalphalangeal joint (MCP) hands)
- wrists
- knees
- feet
describe the stiffness in RA
- morning stiffness can last anywhere from 1 hr - several hours
what are acute manifestations of RA characterized by
- exacerbations & remission
what 2 other manifestations occur w acute RA
- vasculitis
- rheumatic nodules
what are rheumatic nodules
- lesions at pressure points
what are chronic manifestations of RA (3)
- subluxation of joints (dislocation)
- muscle wasting
- deterioration of tendons & ligaments
what does the deterioration of tendons and ligaments lead to (2)
- joint instability
- deformity
what are 4 types of joint deformitys that can occur w RA
- ulnar drift
- boutonniere deformity
- hallux valgus
- swan-neck deformity
what is ulnar drift
- fingers drift towards the ulna
what is boutonnier deformity
- called “hitch hikers thumb” if it occurs in the thumb
- flexion of the fingers at the PIP joint, where they can not straighten out
what is hallux valgus
- drifting of the big toe laterally
what is swan-neck deformity
- binding at base of the finger, hyperextension of PIP joints, with flexion of the DIP
(i recommend looking up a picture)
what are ways to diagnose RA
- history
- physical findings
- positive RF
- elevations in ESR and c-reactive protein
what do elevation in ESR and c-reactive protein indicate
- inflammation
what are complications of RA (6)
- joint destruction
- flexion contractures & hand deformities
- nodular myositits
- muscle fiber degeneration
- cataracts & loss of vision
- later, cardiopulmonary effects
what are 4 types of treatments for RA
- NSAIDs
- glucocorticoids
- DMARDS
- TNF antagonists
what are DMARDS
- disease modifying antirheumatic drugs
what is a type of non-biologic DMARD used for RA
- methotrexate
what is the MOA of methotrexate
- causes immunosuppression
- reduced activity of B and T lymphocytes that are attacking the joints
describe the effectiveness & onset of methotrextate
- fastest acting DMARD (works in 3-6 weeks)
- 80% will improve w this drug
what should be taken w methotrextae? why (2)
- folic acid
- to reduce GI and liver toxity
what is a contraindication for methotrexate
- highly teratogenic
what are s/e of methotrexate (5)
serious toxicities of the:
- GI tract
- bone marrow
- liver
- lungs
- kidneys
what should be monitored during treatment of RA with methotrexate
- LFTs (liver fnxn test)
- renal function test
- CBC
what are TNF antagonists
tumor necrotic factor antagonists
what is one type of TNF antagonist used for RA
- infliximab
what is infliximab r/t DMARDs? what does this mean?
biologic DMARD
= targets specific cellular components of the inflammatory process
what is the MOA of infliximab
- antibody that binds to & neutralizes TNF
what is infliximab often given with? how is it adminsitered?
- often w methotreate but can be alone
- given IV
what are 2 main side effects of infliximab
- immune suppression
- infusion rxn
what should you monitor regarding the s/e of immunosuppression w infliximab
- increased risk of infection
- dose should be held iif acute infection is present
what are signs of an infusion rxn (5)
- flu-like symptom
- headache
- fever
- GI disturbances
- hypotension
what can you use to treat the infusion rxn
- tylenol
- antihistamine
