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Session 4 CM Rheum-1

CM- Rheum -1- RA

What is the peak onset for R.A. age 25-45
Who suffers more from R.A. M or F F>M 3:1
When is a women likely to experience relief from R.A. improves during pregnancy and flares 4-6 weeks post partum
What effect does R.A. have on mortality rates in general Pts with rheumatoid arthritis have higher mortality than Gen'l population
What are the classification criteria for R.A. at least 4 of the following for >6wks; morning stiffness lasting >1hour, swelling in 3 or more joint areas, swelling in hand joints, symmetric joint swelling, rheumatoid nodules, rheumatoid factor, erosions or osteopenia on hand x-ray
What is the pathophysiology of R.A. I.e. what is the underlying cause swollen inflamed synovial membrane
What is the pathognomonic cellular finding for R.A. Pannus (hypertrophic Synovium)
What is the problem with pannus (hypertrophic Synovium) normally synovium doesn't cover cartilage in R.A. you get invasion of synovium into the cartilage, tendons and ligaments
What joints are classically involved in R.A. MCPs, PIPs (80%), Wrist 80%, Knee 80%, Ankle Subtalar 80%, MTPs 90%, shoulder 60%, C-Spine 40%, TMJ 30%
What joints are noticeably absent in involvement in R.A. Spine except C-Spine
Which hand joint is spared in R.A. DIP joints are typically spared
If you find ulnar deviations, interossei atrophy and subluxations what stage of R.A. is your patient in advanced stages
Outside of the joint you can get signs and symptoms of R.A. name 5 Rheumatoid Nodules, Sjogren's syndrome, Felty's syndrome, vasculitis, Rheumatoid lung, cardiac disease, neuromyopathy, inflammatory eye disease, osteoporosis, lymphadenopathy, hyperviscosity, cryoglobulinemia, dermatologic, amyloidosis
If pt has rheumatoid nodules what other positive finding will you always find Always Rheumatoid Factor +
Your pt presents with R.A. and sever neck pain radiating to occiput, have diminished motor power in arms/legs, dysesthesias of the fingers/feet, marble sensation in the limbs/trunk, jumping legs, disturbed bladder function what could be causing this Myelopathic leading to spinal cord damage from degeneration of the C-SPINE
What is Sjogren's syndrome autoimmune exocrinopathy, sicca symptoms (dry eyes, mouth, vagina, tracheo-bronchial dryness) associated with SS-A (RO) and SS-B (LA) antibodies and is tx symptomatically
What is the schirmer's test for tests for tear production can help identify Sjogren's or other malfunction in tear formation
What are nail fold infarcts small vessel vasculitis that can indicated R.A.
What lab findings are you likely to find in R.A. + rheumatoid factor, Anti CCP antibody, Elevated ESR or CRP, Anemia, Thrombocytosis, ANA +, Hyperglobulinemia, Leukopenia/granulocytopenia, glucose in body fluids very low
Besides R.A. what other disease may show rheumatoid positive finding Syphilis, sarcoidosis, SLE, SBE, T.B., Leprosy, Parasitic infections, Viral Disease, advanced age, autoimmune disease
What are the two areas of R.A. that we can effectively tx alleviate pain, slow rate of joint damage
What is one of the limitations of DMARDs for tx of R.A. high discontinuation rate (toxicity/efficacy) needs continued monitoring, has delayed onset of action
What type of drug are these- Hydroxychloroquine (Plaquenil), Sulfasalazine (Azulfidine), Gold Compounds, Azathioprine (Imuran), D-Penicillamine (D-pen & Cuprimine), Cyclosporine (Sandimmune), Methotrexate (Rheumatrex, Trexall), Leflunomide (Arava) DMARDs
What are the pros of using methotrexate long term clinical experience, favorable rate of continuing therapy, proven efficacy in moderate-severe RA
What are the Cons of using methotrexate Lab Monitoring 4-8wks, Toxicities; hepatic, myelosuppression, pulmonary
What are the pros of using Leflunomide Well absorbed PO, early onset of action, stabilized benefit for long-term use, selectively target autoimmune lymphocytes to reduces AEs
What are the cons of Using Leflunomide Lack of Clinical Experience, Toxicities- hepatic, GI, Teratogenic
How does etanercept (Enbrel) help tx RA Soluble TNA alpha receptor binds TNF-alpha a pro inflammatory cytokine helps reduce inflammation
When would etanercept be indicated moderate to severe RA prior DMARDS failure
What are the adverse rxn from using etanercept injection site reaction, infection (including TB), Cephalgia, Rhinitis
How does Infliximab (Remicade) work in tx of RA Chimeric Monoclonal anti-TNF antibody, blocks action of TNF has rapid onset of action used in combo with MTX
When would Infliximab be indicated for use Moderate to Severe RA with prior DMARDS failure
What are the adverse rxns of using Infliximab (Remicade) in RA URI, cephalgia and Nausea, Increased incidence of TB
How does Adalimumab (Humira) work in tx of RA Fully humanized monoclonal anti-TNF antibody blocks action of TNF, used in combo with MTX, rapid onset of action
When would you use Adalimumab in tx of RA moderate to severe RA prior DMARDS failure
What are the s/e to using Adalimumab (Humira) URI, Cephalgia, Nausea, increased incidence of TB
Created by: smaxsmith