Rheumatoid Arthritis PDF

11/21/23, 3:18 PM Realizeit for Student Summary Rheumatoid arthritis (RA) is an autoimmune disease. The immune system, which usually fights infection, attacks the lining of the joints, causing them to become inflamed. Over time the joints may become permanently damaged and stop working properly. T...

11/21/23, 3:18 PM Realizeit for Student Summary Rheumatoid arthritis (RA) is an autoimmune disease. The immune system, which usually fights infection, attacks the lining of the joints, causing them to become inflamed. Over time the joints may become permanently damaged and stop working properly. The symptoms of rheumatoid arthritis usually come and go. Sometimes symptoms only cause mild discomfort, but other times they can be very painful, making it difficult to move around and do everyday tasks. When symptoms become worse, this is known as a flare-up. A flare-up is impossible to predict, making rheumatoid arthritis difficult to live with. At present there is no known cure for rheumatoid arthritis. However, with early diagnosis and treatment symptoms can be eased and the progression of the condition can be slowed down. The symptoms of rheumatoid arthritis tend to develop gradually, with the first symptoms often being felt in small joints, such as the fingers and toes. Symptoms Joint pain and swelling - This is usually worst in the morning and tends to improve as you move around. Joint stiffness - Again, this often improves once you start moving around. Warmth and redness - The lining of the affected joint becomes inflamed, leaving the skin over the joint warm, red and swollen. Skin nodules - One in four people with rheumatoid arthritis develop lumps under their skin, known as rheumatoid nodules. These commonly occur on the skin over the elbows and forearms, and are usually painless. Anemia - This is a condition where the blood is unable to carry enough oxygen due to a low number of red blood cells. It often leaves you feeling tired and lethargic. Eight out of ten people with rheumatoid arthritis are anemic. Diagnosis Erythrocyte sedimentation rate (ESR) - Red blood cells are placed into a test tube of liquid. They are then timed to see how fast they fall to the bottom of the tube, in millimeters per hour. If they are sinking faster than usual, this could mean that you have an inflammatory condition such as rheumatoid arthritis. C-reactive protein (CRP) - If CRP levels are elevated, there is inflammation in your body. Rheumatoid factor - A specific antibody, known as the rheumatoid factor, is present in the blood. This abnormal antibody is present in eight out of ten people with rheumatoid arthritis. However, this antibody cannot always be detected in the early stages of the condition. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IX01cMmy1tXd%2bA0lN30h55hoLMwB%2fCluMLMNMH… 1/4 11/21/23, 3:18 PM Realizeit for Student Treatment includes: Medications: NSAIDs, corticosteroids, and DMARDs Surgery (replacing the joint with an artificial one, removal of the synovium “synovectomy”, “arthrodesis” (joint fusion) where the joint is removed and the bones are fused together with a bone graft. Management with: Lifestyle changes (developing plans for rest and exercise) Joint support: splints, using assistive device Stay healthy and low stress (cause flare-up) Immunosuppressants are used to decrease the immune response in allergic and autoimmune disorders. RA is treated with three classes of drugs: NSAIDs, glucocorticoids, and disease modifying antibody antirheumatics (DMARDs).DMARDs can be divided into two groups: nonbiologic DMARDs, which are small molecules produced by conventional chemical techniques, and biologic DMARDs, which are large molecules produced by recombinant deoxyribonucleic acid (DNA) technology. DMARDs delay disease progression and reduce joint injury, but the onset of effects is delayed. In the past, treatment of RA was initiated with NSAIDs alone; DMARDs were added only after NSAIDs could no longer control symptoms. Today, guidelines recommend initiating DMARDs within 3 months of diagnosis of RA; the rationale is to delay joint degeneration and retard disease progression. During the DMARD latency period, NSAIDs (and sometimes glucocorticoids) are used to control symptoms. NSAIDs are much safer than glucocorticoids and DMARDs. NSAIDs act quickly to relieve symptoms but do not prevent joint injury and do not delay disease progression. Glucocorticoids act quickly and may delay disease progression. Because glucocorticoids cause serious toxicity when used long term, they are generally reserved for short-term use to control symptoms while responses to DMARDs are developing or supplement other drugs when symptoms flare. NSAIDs inhibit COX enzymes, which are required for prostaglandin formation. NSAIDs inhibit both COX-1 and COX-2. The COX-2 inhibitor, celecoxib, is more selective for the COX-2 enzyme. Prostaglandins produced by COX-1 are important in regulating homeostasis and are associated with platelet aggregation and protective effects on the stomach and kidneys. Drug-induced inhibition results in gastric ulceration, renal dysfunction, and diminished blood clotting. Prostaglandins produced by COX-2 are associated with pain and inflammation. Drug-induced inhibition results in therapeutic effects of analgesia and anti-inflammatory activity. People with hypersensitivity to aspirin should not take NSAIDs due to the risk of crosssensitivity to other antiprostaglandin drugs. The use of gastroprotective drugs such as antacids, H2 blockers, and proton pump inhibitors may be indicated to prevent upper GI bleeding with chronic use of aspirin and other nonselective NSAIDs. Second-generation NSAIDs (cyclooxygenase-2 [COX-2] inhibitors, coxibs) may cause less gastrointestinal (GI) ulceration than first-generation NSAIDs, but they are more expensive. The doses of NSAIDs used for RA are much higher than the doses used to relieve pain or fever. There are two main classes of NSAIDs: (1) first-generation NSAIDs, which inhibit COX-1 and COX-2, and (2) second-generation NSAIDs (coxibs), which selectively inhibit COX-2. The https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IX01cMmy1tXd%2bA0lN30h55hoLMwB%2fCluMLMNMH… 2/4 11/21/23, 3:18 PM Realizeit for Student glucocorticoids are powerful antiinflammatory drugs that can relieve symptoms of severe RA and may also retard disease progression. Methotrexate, a nonbiologic DMARD, acts relatively quickly and is considered the DMARD of first choice by most rheumatologists. Etanercept, a biologic DMARD, neutralizes tumor necrosis factor (TNF), thereby suppressing the autoimmune attack on joints. Etanercept and other TNF antagonists pose a significant risk of serious infections (e.g., bacterial sepsis, invasive fungal infections, tuberculosis, and hepatitis B infection) and are associated with rare cases of heart failure, liver failure, hematologic disorders, neurologic disorders, severe allergic reactions, and cancer. Recognizing pharmacogenomic differences and integration of a new generation of technology has personalized immunologic drug regimens that maximize therapeutic effects and minimize adverse drug effects. Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that occurs when the body's immune system attacks the body’s own tissues and organs. Inflammation caused by lupus can affect many different body systems — including joints, skin, kidneys, blood cells, brain, heart, and lungs. Lupus can be difficult to diagnose because its signs and symptoms often mimic those of other ailments. The most distinctive sign of lupus — a facial rash that resembles the wings of a butterfly unfolding across both cheeks — occurs in many but not all cases of lupus. Some people are born with a tendency toward developing lupus, which may be triggered by infections, certain drugs, or even sunlight. While there is no cure for lupus, treatments can help control symptoms. The most common signs and symptoms include the following: Fatigue Fever Joint pain, stiffness, and swelling Butterfly-shaped rash on the face that covers the cheeks and bridge of the nose or rashes elsewhere on the body Skin lesions that appear or worsen with sun exposure (photosensitivity) Fingers and toes that turn white or blue when exposed to cold or during stressful periods (Raynaud's phenomenon) Shortness of breath Chest pain Dry eyes Headaches, confusion, and memory loss Some potential triggers include sunlight, infections, and medication, such as certain types of blood pressure medications, anti-seizure medications, and antibiotics. People who have drug-induced lupus usually get better when they stop taking the medication. Rarely, symptoms may persist even after the drug is stopped. Risk factors https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IX01cMmy1tXd%2bA0lN30h55hoLMwB%2fCluMLMNMH… 3/4 11/21/23, 3:18 PM Realizeit for Student Factors that may increase the risk of SLE include: Lupus is more common in women. Age - most often diagnosed between the ages of 15 and 45. Race - more common in African-Americans, Hispanics and Asian-Americans. Complications Kidneys - serious kidney damage, and kidney failure is one of the leading causes of death among people with lupus. Brain and central nervous system - patient may experience headaches, dizziness, behavior changes, vision problems, and even strokes or seizures. Many people with lupus experience memory problems and may have difficulty expressing their thoughts. Blood and blood vessels - anemia and increased risk of bleeding or blood clotting. It can also cause vasculitis. Lungs - patients may develop pleurisy, which can make breathing painful. Bleeding into lungs and pneumonia also are possible. Heart - inflammation of the myocardium, arteries or pericarditis. The risk of cardiovascular disease and heart attacks increases greatly as well. Diagnosing lupus is difficult because signs and symptoms vary considerably from person to person. Signs and symptoms of lupus may vary over time and overlap with those of many other disorders. No one test can diagnose lupus. The medications most commonly used to control lupus include: Nonsteroidal anti-inflammatory drugs (NSAIDs). Antimalarial drugs such as hydroxychloroquine (Plaquenil), affect the immune system and can help decrease the risk of lupus flares. Corticosteroids - Prednisone and other types of corticosteroids can counter the inflammation of lupus. High doses of steroids such as methylprednisolone (A-Methapred, Medrol) are often used to control serious disease that involves the kidneys and brain. Immunosuppressant - may be helpful in serious cases of lupus. Examples include methotrexate (Trexall). Rituximab (Rituxan) can be beneficial in cases of resistant lupus. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IX01cMmy1tXd%2bA0lN30h55hoLMwB%2fCluMLMNMH… 4/4