Rheumatoid Arthritis Overview
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Questions and Answers

What is the main cause of rheumatoid arthritis?

  • Bacterial infections in the joints
  • Wear-and-tear on the joints over time
  • The immune system attacking the body's tissues (correct)
  • Overuse of joints in physical activities

    • Which of the following symptoms is commonly associated with rheumatoid arthritis?

  • Skin rash that appears suddenly
  • Joint stiffness that worsens in the evenings
  • Numbness in extremities
  • Swollen and tender joints (correct)

    • What type of medications are primarily used in the treatment of rheumatoid arthritis?

  • Hormonal therapies
  • Corticosteroids and disease-modifying anti-rheumatic drugs (correct)
  • Pain relievers exclusively
  • Antibiotics for bacterial infections

    • In which joints does early rheumatoid arthritis typically start?

    <p>Smaller joints like fingers and toes</p> Signup and view all the answers

    What is a common characteristic of the joint symptoms experienced in rheumatoid arthritis?

    <p>Symptoms are symmetrical, affecting the same joints on both sides</p> Signup and view all the answers

    What is the primary target of treatment in rheumatoid arthritis?

    <p>Achieving clinical remission</p> Signup and view all the answers

    What non-pharmacological therapy is recommended for patients with rheumatoid arthritis?

    <p>A balance of rest and movement</p> Signup and view all the answers

    What percentage of people with rheumatoid arthritis may experience symptoms not involving the joints?

    <p>40 percent</p> Signup and view all the answers

    What is the appropriate action regarding prednisone when the dosing is 40 mg for five days?

    <p>Discontinue without a taper</p> Signup and view all the answers

    Which of the following is a potential side effect of short bursts of steroids?

    <p>Increased risk of gastrointestinal bleeding</p> Signup and view all the answers

    What should be screened for before starting a Disease-Modifying Antirheumatic Drug (DMARD)?

    <p>Hepatitis B and C</p> Signup and view all the answers

    Which condition is not a contraindication for methotrexate use?

    <p>Hypertension</p> Signup and view all the answers

    What is a serious potential effect highlighted in the Black Box Warning of infliximab?

    <p>Serious infections</p> Signup and view all the answers

    Hydroxychloroquine is primarily used to treat which of the following conditions?

    <p>Rheumatoid arthritis</p> Signup and view all the answers

    What effect can methotrexate have on vaccinations?

    <p>Reduces the response to vaccinations</p> Signup and view all the answers

    Which of the following describes leflunomide?

    <p>An immunosuppressant with potential hepatotoxicity</p> Signup and view all the answers

    Which of the following actions should be taken with hydroxychloroquine therapy?

    <p>Monitor for retinal damage</p> Signup and view all the answers

    Which of the following DMARDs is known as the fastest-acting?

    <p>Methotrexate</p> Signup and view all the answers

    When using tumor necrosis factor (TNF) inhibitors, what is a shared concern among all TNF inhibitors?

    <p>Increased risk of serious infections</p> Signup and view all the answers

    What should patients be instructed regarding alcohol consumption while on methotrexate?

    <p>Alcohol should be avoided entirely</p> Signup and view all the answers

    For long-term therapy, when is the recommended way to reduce the dose of corticosteroids?

    <p>By 2.5 to 5.0 mg every 3–7 days</p> Signup and view all the answers

    Which drug is primarily utilized for serious infections and malignancies in autoimmune conditions?

    <p>Infliximab</p> Signup and view all the answers

    What is the primary mechanism by which NSAIDs alleviate symptoms?

    <p>Inhibiting cyclooxygenase (COX)</p> Signup and view all the answers

    Which class of NSAIDs is specifically designed to target COX-2?

    <p>Second-generation NSAIDs</p> Signup and view all the answers

    What is a significant risk associated with the long-term use of NSAIDs?

    <p>Gastrointestinal bleeding</p> Signup and view all the answers

    In what general condition are glucocorticoids most often used?

    <p>To suppress immune function</p> Signup and view all the answers

    Which of the following is a potential side effect of corticosteroid use?

    <p>Mood instability</p> Signup and view all the answers

    What should be considered when utilizing corticosteroids for a prolonged period?

    <p>The risk of adrenal suppression</p> Signup and view all the answers

    What is the purpose of tapering corticosteroids after prolonged use?

    <p>To allow adrenal glands to resume function</p> Signup and view all the answers

    Which steroid is commonly recommended for women at risk of preterm labor?

    <p>Dexamethasone</p> Signup and view all the answers

    Which warning is associated with the use of NSAIDs?

    <p>Risk of cardiovascular events</p> Signup and view all the answers

    What is a key characteristic of first-generation NSAIDs?

    <p>They inhibit both COX-1 and COX-2</p> Signup and view all the answers

    What should patients be informed about regarding systemic corticosteroid use?

    <p>To monitor and use the lowest effective dose</p> Signup and view all the answers

    Which condition might require corticosteroids as a treatment option?

    <p>Severe allergic reactions</p> Signup and view all the answers

    When used during pregnancy, corticosteroids should be administered at what type of dosage?

    <p>Lowest dose for the shortest time</p> Signup and view all the answers

    What is a common feature of both NSAIDs and glucocorticoids?

    <p>Both provide rapid symptom relief</p> Signup and view all the answers

    Study Notes

    Rheumatoid Arthritis

    • Rheumatoid arthritis (RA) is a chronic, autoimmune inflammatory disorder that affects more than just joints.
    • It can damage various body systems, including skin, eyes, lungs, heart, and blood vessels.
    • RA occurs when the immune system attacks the body's tissues.
    • It causes painful joint inflammation, potentially leading to bone erosion and joint deformity.
    • Inflammation can damage other parts of the body.
    • RA often starts with smaller joints, eventually spreading to wrists, knees, ankles, elbows, hips, and shoulders.
    • Symptoms are usually symmetrical.
    • Approximately 40% experience non-joint symptoms.
    • RA can affect numerous non-joint structures.
    • Treatment aims to lessen pain, inflammation, and joint stiffness; minimize systemic symptoms; and slow disease progression.
    • Clinical remission is the primary treatment goal, though low disease activity might suit some patients.

    Medications for Rheumatoid Arthritis

    • Nonsteroidal anti-inflammatory drugs (NSAIDs): Used for fast symptom relief. Safer than glucocorticoids/DMARDs. Inhibit cyclooxygenase (COX) enzymes.

      • First-generation NSAIDs inhibit COX-1 and COX-2.
      • Second-generation NSAIDs target COX-2 only.
      • Examples include aspirin, ibuprofen, naproxen, diclofenac, meloxicam, and celecoxib (COX-2 inhibitor).

    • Black Box Warning for NSAIDs: Increased risk of serious cardiovascular events (MI, stroke), and GI adverse events (bleeding, ulceration, perforation). Risk higher in patients with cardiovascular disease or risk factors.

    • Glucocorticoids (Corticosteroids): Powerful anti-inflammatory agents that can relieve symptoms and potentially slow disease progression. Reserved for widespread symptoms, flares, or when starting a DMARD.

      • Long-term use should be a last resort due to numerous risks.
      • Risks: Alter glucose and lipid metabolism, fluid/electrolyte balance; affect numerous bodily systems.
      • Common side effects include: altered metabolism (hyperglycemia, protein wasting, increased lipid deposition), altered immune response (masking infection), impaired bone health (osteoporosis), skin changes, neurological impacts, cardiac issues (hypertension), ocular problems (glaucoma, cataracts), tremors, hunger, agitation, aggression.
      • Chronic use can lead to hypothalamic-pituitary-adrenal axis suppression (HPA axis), Cushing's syndrome, osteoporosis, immunosuppression, and skin changes (atrophy, striae, telangiectasia, acne.)

    • Disease-Modifying Antirheumatic Drugs (DMARDs): Drugs that modify the course of RA and can induce remission.

      • Methotrexate (Rheumatrex): Folic acid antagonist that suppresses inflammation and cell replication. Highly effective, but contraindicated during pregnancy and breastfeeding. Risk of bone marrow suppression, renal impairment, hepatotoxicity, secondary malignancy, dermatologic toxicity, secondary infections, severe toxic reactions, embryo-fetal toxicity. Avoid alcohol.
      • Infliximab (Remicade): Monoclonal antibody that binds to TNFα, reducing the body's attack on itself.
      • Leflunomide (Arava): Powerful immunosuppressant. Effective but more hazardous and expensive than methotrexate.
      • Hydroxychloroquine (Plaquenil): Antimalarial drug with a mechanism of action not fully understood in RA. Can cause retinal damage (leading to blindness in rare cases). Prolongs QT interval.

    DMARDs (Continued)

    • Biologic DMARDs - Tumor Necrosis Factor Inhibitors (TNF-i): These drugs inhibit TNF, but carry similar risks as infliximab.

      • Black Box Warnings for these and other DMARDs include heightened risk of serious infections, severe allergic reactions, and malignancy.

    Special Considerations

    • Pregnancy and Lactation:
      • Corticosteroids, such as betamethasone and dexamethasone, may be used in pregnancy for preterm labor to stimulate fetal lung maturity. Low doses of systemic corticosteroids might be suitable with breastfeeding. Topical corticosteroids are also safe.
      • Use lowest dose for shortest time possible. Avoid systemic use beyond two weeks.
    • Patient Education:
      • Monitor patients carefully, using the lowest effective dose to mitigate side effects.
      • Inform patients about risks and discuss lifestyle modifications.
      • Take corticosteroids with a full glass of water after meals. Keep doses to 20mg or less at a time.
      • Tapering corticosteroids allows adrenal glands to recover normal function to prevent complications.

    Tapering Steroids

    • Corticosteroid tapering reduces the dose gradually over several days or weeks, depending on the initial dosage, to prevent adrenal insufficiency.

    Important additional considerations:

    • Short-burst steroid use: While short-bursts (less than 2 weeks) are commonly used, they are not as safe as once thought. During and after short-burst durations, monitor patients closely, for GI bleeding, sepsis and heart failure, especially during the first month. Patient education is critical to minimize risk.
    • Prior Medical Testing / immunizations: Before starting DMARDs, screen for Hepatitis B, C, and latent TB. Administer age-appropriate immunizations, prior to starting DMARDs. Live vaccines are contraindicated once treatment begins.
    • Medication Interactions: Be aware of potential drug interactions between the mentioned drugs and potentially other medications, particularly methotrexate with alcohol or other liver-metabolized drugs.

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    Description

    This quiz covers the fundamental aspects of rheumatoid arthritis (RA), including its effects on the body, symptoms, and treatment goals. Participants will learn about the autoimmune nature of RA and the importance of managing both joint and non-joint symptoms. Test your knowledge on this chronic inflammatory disorder.

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