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50 Cards in this Set
- Front
- Back
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ra
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autimmune dz where the body loses its ability to distinguish between synovial and foreign tissue
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factors invlove in ra
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environmental influences
genetic markers tumor necrosis factor alpha interleukin1 IL-6 growth factors inflammed synovium |
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environmental influences
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bacterial and viral infxn
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HLA-DR4
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human leukocyte antigent has been assoc with triggering the inflam process in RA
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tumor necroses factor alpha
interleukin 1 growth gactors |
propagate the inflam process and agents found to alter these cytokines show promise in reducing pain and deformity
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inflammed synovium
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hallmark of the pathophysiology of ra
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synovium
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proliferated abnormally, growing into the joint space and into the bone forming a pannus
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pannus
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migrates to the srticular cartilage and into the subchondral bone
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stimulation of the cytokines
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cells of the pannus produce proteolytic enzymes
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proteolytic enzymes
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degrade cartilage
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cytokines
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activate osteoclasts which causes the demineralization of bone
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ra sx
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malaise
anorexia tender, swollen joints |
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pain the joints
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aggravated by movement
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metacarpophalangeal (MCP)
proximal interphalangeal (PIP) |
joints 1st affected by ra
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PIP
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joints of hands
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metatarsophalangeal (MTP)
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joints of the feet and wrist
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other areas aff by ra
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spine
shoulder ankle hip |
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extra-articular manifestations of ra
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rheumatoid nodules
anemia peripheral neuropathy kidney dz CV pulmonary dz |
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osteoporosis
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may occur 2ndary to ra in pts rec tremt w/ corticosteroids
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criteria for ra
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- morning stiffness
- arthritis of 3 or more joint area - arthritis of hand joints - symmetrical arthritis -rheumatoid nodules -serum rheumatoid factor -radiological changes |
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symmetrical arthritis
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simultaneous involvement of the same joint areas on both sides of the body
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rheumatoid nodules
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observable subcutaneous nodules over bony prominences or extensor surfaces
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lab assessment
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rheumatoid factor
erythrocyte sedimentation rate c-reactive protein cbc antinuclear antibody radiographic exam |
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rheumatoid factor (rf)
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IgM
IgG IgA |
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erythrocyte sedimentation rate (ESR)
C reactive protein (CRP) |
markers of inflam
elevated helpo indicate the activity of dz |
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common in ra
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anemia
hypochromic mild leukocytosis |
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antinuclear antibody (ANA)
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+ in ra
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radiograph
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good indicator of the extent of bone erosion and cartilage loss
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MRI
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detects the proliferative pannus
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ra drug list
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salicylates
nsaids cox 2 corticosteroids dmard etanercept infliximab anakinra |
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reduce joint pain
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salicylates
nsaids cox2 |
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corticosteroids
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prednisone
methylprednisolone |
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bridge therapy
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corticosteroids
aninflam immunosuppressants |
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disease modifying antirheumatic drugs
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dmards
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objective of dmard
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reduce or prevent joint damage and preserve joint fxn
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inflammatory markers
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esr
crp |
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more commonly used dmards
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hydroxychloroquine
seulfasalazine methotrexate |
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less frequently used dmards
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auranofin
azathioprine cyclosporine gold salts d-penicillamine |
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newer dmards
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leflunomide
etanercept infliximab anakinra |
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leflunomide
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inhibits pyrimidine synthesis and is indicated as monotherapy for ra
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hepatotoxicity
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assoc with use of leflunomide
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etanercept
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binds to TNF aldpha and Beta
inhibiting the inflam response mediated by immune cells |
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indication etanercept
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monotherapy
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immunosuppression
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occurs with use of etanercept
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edv eff enbrel
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pancytopenia
lupus like sx paresthesias visual gait disturbances confusion |
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infliximab
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binds to TNF alpha and only FDA approve in combo with methotrexate
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se of infliximab
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immunosuppression
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anakinra
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newest dmard
interleukin 1 rec antagonist |
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se of anakinra
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immunosuppression
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triple therapy of ra
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mtx
hydroxychloroquine sulfasalazine |
