Module 3 Study Guide Part 3.docx

**[Rheumatoid Arthritis (RA)] Autoimmune disorder** **Chronic systemic inflammation including the synovial membranes of multiple joints** - Shortens lifespan and increases risk of cardiovascular disease and stroke. **Goal of treatment:** - Reduce inflammation and pain while preserving fu...

**[Rheumatoid Arthritis (RA)] Autoimmune disorder** **Chronic systemic inflammation including the synovial membranes of multiple joints** - Shortens lifespan and increases risk of cardiovascular disease and stroke. **Goal of treatment:** - Reduce inflammation and pain while preserving function and preventing joint damage/deformity. **First line treatment:** - NSAIDs with Disease-Modifying Antirheumatic Drugs (DMARDs). **DMARDs:** **-Traditional DMARDs:** - Methotrexate 1^st^ line for mod-severe Bone marrow suppression, hepatic fibrosis, GI ulceration, pneumonitis - Hydroxychloroquine 2^nd^ line for mild retinal damage - Leflunomide teratogenic - Sulfasalazine GI effects - Minocycline - Penicillamine - Azathioprine - Cyclosporine **-Biological response modifiers: RISK OF CANCER INFECTIONS! Receive all recommended vaccinations. YEARLY TB TESTING!** **Non-TNF:** - Rituximab- reduces number of B lymphocytes - A/E: infusion reactions, mucocutaneous reactions, Hep B reactivation, progressive multifocal leukoencephalopathy - Abatacept - Tcell activation inhibitor - A/E: headaches, upper respiratory infections, nasal pharyngitis - Avoid live vaccines - Anakinra - Blocks receptors for interleukin 1 - Infections - Tocilizumab - Interleukin-6 receptor antagonist helps mediate the autoimmune attack against joints - A/E: infections, GI perforation, liver injury, neutropenia/thrombo **Anti-TNF: inactivates TNF** - Etanercept: - A/E: infections, heart failure, hematologic disorders - Avoid live viruses - Infliximab - Adalimumab - Certolizumab - Golimumab **Oral JAK inhibitors:** - Tofacitinib - Ruxolitinib **Note:** All these drugs suppress the immune system. **[Gout ]** **Cause:** - Excessive production of uric acid. - Impaired renal excretion of uric acid secondary to acidosis - Diuretics (should not be on thiazide) - Over production: cirrhosis, hematologic malignancies, dietary excess of purines/alcohol Seen in great toe mostly After first attack put them on preventive! During the first attack you can put them on preventive IF they have tophaceous gout or damage that shows up on xray **Preventive medications:** **Xanthine oxidase inhibitors (agents that decrease uric acid production):** - **Allopurinol:** First-line treatment. Inhibition of xanthin oxidase, an enzyme required for uric acid formation - Hypersensitivity with HLA-B allele Asian/ AA decent must have HLA testing - 100mg or less daily increases every 2-5 weeks for urate level \