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RHEUMATOID ARTHRITIS

RHEUMATOID ARTHRITIS. Balqis Mohamad Zin (F0155) 15 th June 2012. What is Rheumatoid arthritis (RA)?. It is an autoimmune disorder T he deregulated immune system starts to attack the joints

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RHEUMATOID ARTHRITIS

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  1. RHEUMATOID ARTHRITIS Balqis MohamadZin(F0155) 15th June 2012

  2. What is Rheumatoid arthritis (RA)? • It is an autoimmune disorder • The deregulated immune system starts to attack the joints • Chronic systemic inflammatory disorders Which the synovial (lines and lubricates the joints) becomes inflamed • According to Arthritis Foundation Malaysia, RA affects about 5 in 1000 people in Malaysia. • Prevalence estimated to be 1% worldwide

  3. Pathophysiology • Begins with inflammation of the synovial lining. • The thin membrane proliferates, and become transformed into the synovial pannus. • The pannus, a highly erosive enzyme-laden inflammatory exudate  invades articular cartilage,  erodes bone  destroys periarticular structures resulting in joint deformities

  4. DiagnosisAmerican Rheumatism Association Criteria (ACR) Patient is said to have RA if she/he satisfied at least 4 of these 7 criteria

  5. Aim • To minimize joint damage • to reduce joint swelling, stiffness and pain • Improve quality of life

  6. Pharmacological treatment

  7. NSAIDS/ COX-2 Inhibitors • As adjunct therapy to DMARDs • Primarily by inhibiting the prostaglandin synthesis. • Reduce stiffness BUT do not slow disease progression or prevent joint deformity • Aspirin • Celecoxib • Diclofenac • Indomethacin • Meloxicam • Naproxen

  8. Corticosteroids • Only given in a short period of time • Helps to reduce the progression rate of disease • Given not more than a year • Low dosages of Oral corticosteroid • 10mg of prednisolone or less • Injected corticosteroid useful when flares involves only a few joints • should not be given more than once every 3 months

  9. Disease-Modifying Antirheumatic Drugs(DMARDs) • Initial therapy once patient diagnosed • Should not be delayed beyond 3 months • Proven to slow down RA activity • May not be effective in up to 20% patients

  10. After DMARD treatment Before DMARD treatment

  11. Methotrexate • Folic acid supplement (5mg/week) will be given as combination to reduce side effects .  MTX is a folate antagonist • Should not be given on the same day as MTX is administered • May reduce the effect of MTX • Compete for dihydrofolatereductase enzyme • Folic acid should be taken on the next day after MTX is taken.

  12. Hydrochloroquine

  13. Cyclosporin

  14. Sulphasalazine

  15. Penicillamine

  16. Azathioprine

  17. Biological Modifiers • Mimic the biological substances in human body • Suppressed excessive macrophage- produced cytokines (TNF-α, IL-1, IL-6, IL-8) which are abundant in rheumatoid synovial tissues and fluids

  18. Rituximab

  19. Etanercept

  20. Infliximab

  21. Source: 2012 Update of the 2008 American College of Rheumatology Recommendations for the Use of Disease-Modifying Antirheumatic Drugs and Biologic Agents in the Treatment of Rheumatoid Arthritis

  22. Source: 2012 Update of the 2008 American College of Rheumatology Recommendations for the Use of Disease-Modifying Antirheumatic Drugs and Biologic Agents in the Treatment of Rheumatoid Arthritis

  23. Monitoring • ESR/CRP • LFT • WBC • Platelet • Creatinine

  24. Non-pharmacological treatment • Occupational therapy • Tai Chi • Passive exercise should prescribed

  25. Joint Protection Principles Source: http://www.afm.org.my/info/living.htm

  26. Treatment available in UMMC

  27. Summary • To minimize the pain and joint damage, proper treatment should be given. • Early treatment !!…. Reversible • Counseling is important • Side effect • Administration

  28. References • BNF • Drug information Handbook. 18th Edition • B.G.Wells, J.T. DiPiro,T.LSchwinghammer, C.V DiPiro. Pharmacotherapy handbook, 7th edition, Mc Graw Hill • M.A Koda-Kimble, L.Y Young, B.K.Alldredge, R.L Corelli, et al,. Applied therapeutics, 9th edition, Lippincott Williams & Wilkins • J.A Singh, D.E Furst, et al. 2012 Update of the 2008 American College of Rheumatology Recommendations for the Use of Disease-Modifying Antirheumatic Drugs and Biologic Agents in the Treatment of Rheumatoid Arthritis, Arthritis & Care Research, Vol 64 No.5 , May 2012. • NICE guideline: The management of Rheumatoid Arthritis in adult, February 2009. • “Stop it Before it Stops You”, by Dr Chow SookKhuan, Consultant Rheumatologist, Sunway Medical Centre , Keep Smiling, Volume 8/2008 • http://www.afm.org.my/info/ra.htm • RHEUMATOID ARTHRITIS, National clinical guideline for management and treatment in adults, Royal College of Physicians • http://www.livestrong.com/article/420615-why-cant-i-take-folic-acid-the-same-day-as-methotrexate/

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