RA
chronic, systemic, autoimmune disease
inflammation of connective tissue in synovial joints
periods of remission and exacerbation
RA peaks when
30-50
RA patho
immune response to an antigen
IgG
RF
immune complexes
complement is activated
inflammatory response
stage 1
synovitis
X-ray shows soft tissue swelling, possible osteoporosis, no joint destruction
stage II
increased joint inflammation
gradual destruction in joint cartilage
narrowing joint space from loss of cartilage
stage III
pannus
xray: extensive cartilage loss, erosion at joint margins, possible deformity
stage IV
inflammatory process subsides
loss of joint function
formation of subcutaneous nodules
RA clinical manifestations
may report history of precipitating event: infection, stress, childbirth, surgery
symmetrical
often affects small joints
joint stiffness after inactivity
morning stiffness
fingers spindle shaped
joints tender, painful, warm to touch
pain worse with motion
DMARDs
Methotrexate
Sulfasalazine (Azulfidine)
Hydroxychloroquine (Plaquenil)
Leflunomide (Arava)
Tofacitinib (Xeljanz)
BRMs
TNF inhibitors
etanercept (Enbrel) SubQ
Infliximab (Remicade) IV infusion
Adalimumab (Humira) SubQ
Certolizumab (Cimzia)
Golimumab (Simponi)
bind with TNF, inhibiting inflammation
TB test and chest xray before start
monitor for infection
avoid live vaccin
Anakinra (Kineret)
IL-1 receptor antagonist
given SQ
reduces pain and swelling
Tocilizumab (Actemra)
IL-6 receptor antagonist
proimflammatory cytokine
Abatacept (orencia)
blocks t cell activation
given IV
Rituximab (Rituxan)
targets B cells
given IV