CM- Rheum -1- RA
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| What is the peak onset for R.A. | age 25-45
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| Who suffers more from R.A. M or F | F>M 3:1
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| When is a women likely to experience relief from R.A. | improves during pregnancy and flares 4-6 weeks post partum
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| What effect does R.A. have on mortality rates in general | Pts with rheumatoid arthritis have higher mortality than Gen'l population
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| 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
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| What is the pathophysiology of R.A. I.e. what is the underlying cause | swollen inflamed synovial membrane
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| What is the pathognomonic cellular finding for R.A. | Pannus (hypertrophic Synovium)
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| 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
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| 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%
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| What joints are noticeably absent in involvement in R.A. | Spine except C-Spine
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| Which hand joint is spared in R.A. | DIP joints are typically spared
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| If you find ulnar deviations, interossei atrophy and subluxations what stage of R.A. is your patient in | advanced stages
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| 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
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| If pt has rheumatoid nodules what other positive finding will you always find | Always Rheumatoid Factor +
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| 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
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| 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
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| What is the schirmer's test for | tests for tear production can help identify Sjogren's or other malfunction in tear formation
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| What are nail fold infarcts | small vessel vasculitis that can indicated R.A.
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| 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
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| 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
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| What are the two areas of R.A. that we can effectively tx | alleviate pain, slow rate of joint damage
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| 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
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| 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
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| What are the pros of using methotrexate | long term clinical experience, favorable rate of continuing therapy, proven efficacy in moderate-severe RA
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| What are the Cons of using methotrexate | Lab Monitoring 4-8wks, Toxicities; hepatic, myelosuppression, pulmonary
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| 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
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| What are the cons of Using Leflunomide | Lack of Clinical Experience, Toxicities- hepatic, GI, Teratogenic
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| How does etanercept (Enbrel) help tx RA | Soluble TNA alpha receptor binds TNF-alpha a pro inflammatory cytokine helps reduce inflammation
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| When would etanercept be indicated | moderate to severe RA prior DMARDS failure
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| What are the adverse rxn from using etanercept | injection site reaction, infection (including TB), Cephalgia, Rhinitis
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| 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
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| When would Infliximab be indicated for use | Moderate to Severe RA with prior DMARDS failure
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| What are the adverse rxns of using Infliximab (Remicade) in RA | URI, cephalgia and Nausea, Increased incidence of TB
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| 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
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| When would you use Adalimumab in tx of RA | moderate to severe RA prior DMARDS failure
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| What are the s/e to using Adalimumab (Humira) | URI, Cephalgia, Nausea, increased incidence of TB
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