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Rheumatoid Arthritis

Rheumatoid Arthritis RA is a classic autoimmune disease with abnormalities of cellular and humoral components of immunity.
Pannus Major cell types: 1. Macrophages 2. T Lymphocytes Minor cell types: 1. Dendritics cells 2. Endothelium 3. Plasma cells 4. Fibroblast
Cellular Immunity relies on thymus to delete self-reactive lymphocytes, forming T-cells.
T-cell - Direct destruction of infected cells. - orchestration of further immune response.
Humoral Immunity - relies on cellular maturation in the bone marrow resulting in B cell.
B-cell 1. production of antibodies 2. contribute to inflammation
COX 1 1. constitutive form of COX. 2. poor inducibility. 3. Smaller active site. 4. PG tat regulate normal kidney & stomach function. 5. substract only C20 carboxylic.acd. 6. main source of PGs in CHRONIC inflammation 7. Acetylation of SEr 530 by aspirin.
COX 2 1. Inducible form of COX. 2. Induced during inflammation. 3. produce PGs inolved in inflammation. 4. larger active site. 5. Substrates C18 & C20 C.A. 6. Main source of PG in ACUTE inflam. 7. Acetylation of ser516.
NSAIDs s/e 1. heartburn 2. dyspepsia 3. abdominal pain - inhibition of prostaglandin which act as the protective of the GI tract. 4. serious: Bleeding/ ulceration * PPI should be prescribed with long term NSAIDs.
Sulfasalazine 500mg once daily nausea/rashes/ bone marrow suppression
Methotrexate 5-25mg once weekly rashes/nausea/ stomatitis/ hepatitis
Sodium aurothiomalate 10mg test then 50mg weekly rashes/ stomatitis/ marrow suppression
penicillame 250-750mg once daily on empty stomach rashes/ nausea/ taste disturbance
cyclosporin 2.5mg/kg/day renal impairment
Leflunomide 10-20mg daily for maintanence, 100mg for loading dose- 3 days GI disturbance/hypertension/alopecia(loss of hair)
Azathioprine 1.5-2.5mg/kg/day nausea/hepatitis/ marrow suppression
Created by: staffi



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