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38 Cards in this Set
- Front
- Back
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TNF in RA stimulates the production of _____________________
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T Lymphocytes
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What is a normal ESR value?
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<20-30 mm/h
RA is elevated |
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What is the normal C-reactive Protein level?
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<0.8 mg/dL
Elevated in RA |
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Step 1 in RA diagnosis
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History
1. Morning Stiffness 2. involves >3 joints 3. Arthritis in hands 4. Bilateral Movement 5. Rheumatoid nodules 6. (+) Rheumatoid factor 7. Radiographic evidence of RA |
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step 2 in Diagnosis
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Physical exam of joints
1. edema 2. effusion 3. warmth 4. Tenderness on palpation |
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step 3 in RA diagnosis
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RA Panel
1. ESR >30 2. C-reactive protein >0.8 3. RF >15 4. Cyclic citrullinated antibodies (anti-CCP) >25 |
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If you have Rheumatoid factor you have RA T/F
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False
found in 5% healthy ppl who nvr get RA |
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normal RF level
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<15
RA >15 |
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This if found confirms RA diagnosis
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anti-CCP
Normal <25 |
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normal anti-CCP
(Cyclic citrullinated antibodies) |
<25
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step 4 in RA diagnosis
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Imaging
Xray CT scan MRI to see deformities, erosions, soft tissue swelling |
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after diagnosis, start ____ within 3 mo of diagnosis
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DMARD
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if inadequate response after 3 mo of MAXIMAL therapy, what would be your next step?
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Add or change DMARD
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This is not recommended in RA patients with CHF Bleeding ulcer, SCr > 2.5mg/dl, or hypovolemia
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NSAID
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This RA med relieves symptoms within days and may slow rate of joint damage
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Glucocorticoids
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What are the ADR of glucocorticoids?
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Osteoporosis
wt gain/HTN hyperglycemia |
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You would use this DMARD early in mild disease.
It is the Least toxic however it takes 1-6 monthe to achieve benefit and it does NOT slow radiologic damage |
Hydoxychoroquine
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This DMARD can relieve symptoms in as little as 4 weeks. It also slows radiographic progression.
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Sulfasalazine
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when should a pt be reviewed for efficacy with sulfasalazine?
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4 months
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what are the SE and Contraindications for Sulfasalazine?
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SE: GI, blood, Rash
Contraindications: Sulfa allergies. Intestinal or urinary obstructions |
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this is the DMARD of choice
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Methotrexate
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What must be supplimented with MTX?
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Folate
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What is the dose of MTX?
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7.5-15 EVERY WEEK!
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This inhibits cytokine production, PURINE synthesis
(inhibits formation of T lymphocytes) |
MTX
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What must you monitor on a pt on MTX?
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signs of infection
LFT monthly for first 6 mo then every 1-2 months thereafter CBC Creatinine |
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This inhibits de novo PYRIMIDINE synthesis by inhibiting dihydrooratate dehydrogenase
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Leflunomide (Arava)
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Must D/C Arava if LFTs > 3x UNL and give ______ 8 grams TID for 11 days
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cholestyramine
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This is an IL-1 receptor antagonist.
(can damage bone) |
Kineret (Anakinra)
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when can you use Anakinra
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when TNF inhibitor cant be used
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Name the 5 TNF-Inhibitors
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1. Cimzia (certolizumab pegol)
2. Simponi (Golimumab) 3. Humira (adalimumab) 4. Remicade (Infliximab) 5. Enbrel (Etanercept) |
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this is used commonly after MTX failure or even in MTX naive patients
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TNF I
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Improvement in symptoms, labs, pain scale should be seen in _____ weeks when on a TNF
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12 weeks
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Which TNF I can you use in young patients?
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Humira, Enbrel
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This TNF is mainly used in Combination with DMARDS
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Remicade
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MOA: Targets and depletes CD20-positive B cells
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Rituximab (Rituxan)
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Use this in combination with MTX in adults with moderate to sever RA who had inadequate response to > 1 TNF inhibitor
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Rituximab (Rituxan)
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What is the dosing for Rituximab?
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two IV infusions seperated by 2 weeks
Premedicate w APAP/Benedryl. IV methylprednisone 100mg administered 30 min b4 each infusion |
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This is used in adults with moderate to severe RA with inadequate response to DMARDS including MTX or TNFIs
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Abatacept (Orencia)
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