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23 Cards in this Set
- Front
- Back
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Rheumatoid arthritis:
A systemic, ... polyarthritis that leads to joint destruction, deformity, and loss of function The pathology of RA involves the ... and periarticular structures of multiple joints, resulting in: -Pain -Swelling -Uncontrolled inflammation that can lead to irreversible damage and deformity -Stiffness -Functional limitation -... formation (erosion in the bone itself) Occurs in younger people, usually females |
inflammatory
synovial membranes Pannus |
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... symptoms and signs commonly occur and may even antedate the onset of joint symptoms
-Fatigue -Weakness -Depression -General malaise -Low-grade fever of undetermined origin -Unexplained weight loss |
Systemic
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RA is a systemic disease involving ... organs
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multiple
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Epidemiology:
Prevalence ranges from 0.5% to ...%, affecting nearly 2.5 million Americans and 165 million people worldwide -Prevalence may be as high as 7% and as low as 0% in different ethnic groups *Up to 7% in certain ... *Virtually 0% in ... and southern Africa -Age of onset is typically between 25 and 50 years (more so in the ...-...) -Female-to-male ratio is approximately...:1 Annual incidence ranges from 14.3 cases per 100,000 in men to 35.9 cases per 100,000 in women |
1
American Indian tribes Asia 20-30s 3 |
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Untreated RA results in higher mortality rates
-27% higher than in the general population (41% higher for ...) -Life expectancy in patients with RA is reduced by as much as ... years compared to age- and sex-matched controls without RA |
women
18 |
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Increased morbidity for patients with RA due to chronic ...
-Twice as likely to develop a myocardial infarction (MI) -70% more likely to suffer a stroke -70% more likely to develop an infection Increased risk of ... -Up to 26-fold higher risk, depending on severity of disease and exposure to immunosuppressive drugs, including methotrexate Increased morbidity for (gender)... with RA -2- to 3-fold increase in the risk of developing an MI -48% higher risk of suffering a stroke |
inflammation
lymphoma women |
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untreated inflammation will lead to eroded ... aka ...
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bone
pannus |
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... was introduced in 1955 and is still the major drug of choice for management of RA to this day
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Prednisone
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Current Pharmacologic Options for RA:
Agents that are effective in controlling the signs and symptoms of RA, but have no effect on disease progression -... reduce inflammation and pain -... inhibitors are similar to NSAIDs, but with improved GI safety and tolerability ... impact the signs, symptoms, and disease progression of RA, as well as improve the quality of life and functionality of the patient ... have anti-inflammatory and immunoregulatory activity, but nominal disease-modifying capability |
NSAIDs
COX-2 DMARDs Corticosteroids |
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Impact of RA
Based on a prospective study, in very early RA, 25% of patients already had ... at their first visit |
erosions
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... are better at detecting erosions (early detection of joint damage) than ... are
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MRIs
X-rays |
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Importance of early and aggressive intervention in RA:
-Damage can occur early and is usually progressive -Damage and symptoms ... correlate -Early intervention can lead to better outcomes -aggressive therapy may be better -early and aggressive therapy can lead to better outcomes |
do not always
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COX-2 Therapy Benefit in RA:
Relief of signs and symptoms Proven ... safety Excellent tolerability Simple dosing |
upper GI
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COX-2 relieves symptoms and is recommended as a component of RA therapy, but it does not ... the disease activity, so it’s not sufficient enough.
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stop
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...:
-INHIBITS DIHYDROOROTATE DEHYDROGENASE -CONVERTS RAPIDLY INTO ACTIVE METABOLITE A77 1726 -side effects: alopecia, skin rashes, diarrhea, nausea |
Leflunomide
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...:
-The cornerstone therapy for RA. Used the most. Very inexpensive. -INHIBITS DIHYROFOLATE REDUCTASE -INHIBITS IL-1 AND LEUKOTRIENE 4 -DECREASES PROTEOLYTIC ENZYMES -A disease modifying drug. Attacks the disease. Side effects: GI side effects mostly, stomatitis, nausea, dyspepsia, headache, abnormal liver tests, pulmonary fibrosis, bone marrow suppression |
Methotrexate
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...:
-Has been in the market for 50 years. Used only for mild RA. -INHIBITS RELEASE OF IL-1 -RETARDS PHAGOCYTIC CHEMOTAXIS -INHIBITS PHOSPHOLIPASE A2 -A disease modifying drug Side effects: GI dyspepsia, diarrhea, nausea, peripheral neuropathy, ocular toxicity (rare) |
Hydroxychloroquine
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...:
-Used for mild to moderate RA -INHIBITS 5 LIPO OXYGENASE -INHIBITIS LYMPHOCYTE MITOGENESIS Side effects: Urticaria, pruritis, leukopenia, neutropenia, nausea abd discomfort |
Sulfasalazine
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...:
-PURINE ANALOGUE INHIBITS SYNTHESIS OF NUCLEIC ACIDS -S/E: HEPATITIS ,PANCREATITIS, MYELOSUPPRESSION |
AZATHIOPRINE (Imuran)
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Traditional DMARDs have been the mainstay of RA therapy, but these agents have provided disappointing long-term results due to:
-Lack of durable, long-term efficacy -High rates of drug discontinuation due to intolerable side effects or adverse events -Inability to inhibit structural progression of disease Aggressive, ... use of traditional DMARDs is now the standard of care and has yielded better outcomes for patients with RA –“Inversion of pyramid” approach – use of DMARDs ... in the course of disease –Rapid dose escalation –... therapy with 2 or 3 drugs |
early
early Combination |
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For patients with RA, biologic DMARDs, used either in combination with ... or as monotherapy:
-Have improved patients’ clinical signs and symptoms -Have inhibited radiographic progression of joint destruction -Have improved patients’ functionality and health-related quality of life, and retarded or prevented disability |
methotrexate
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...:
-This is a chimeric Anti Cd20 monoclonal antibody that causes selective and transient depletion of the CD 20 B cell population -Works well for treatment of lymphoma also |
Rituximab
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...:
This is a soluble fusion protein consisting of external domain of human CTLA4 and the heavy chain constant region of human igG This binds to CD80 and CD86 on the APC preventing their costimulatory interaction with CD 28 on the T cell surface |
Abatecept
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