RA

MOA: inhibit the generation of prostaglandins by blocking cyclooxygenase enzymes, COX-1 and COX-2. Prostaglandins are mediators of inflammation and pain.

NSAIDS

are medications that can reduce tissue inflammation, pain, and swelling. However that these drugs alone do not change the course of the disease of rheumatoid arthritis or prevent joint destruction

NSAIDS

The fast-acting drugs for RA

NSAIDS and corticosteroids

works by binding to (IL-1, a pro-inflammatory cytokine). It is injected under the skin daily. It can be used alone or with other DMARDs. The response rate does not seem to be as high as with other biologic medications

Anakinra (Kineret)

In order to reduce gastrointestinal side effects and protect the stomach from the ulcer effects of NSAIDs other medications are recommended to

Be taken with food

Because of potentially serious side effects, these medicines (other than methotrexate) are generally used for very aggressive disease or those with serious complications of rheumatoid inflammation, such as blood vessel inflammation (vasculitis). It can can affect the bone marrow and the liver, even rarely causing cirrhosis.

Immunosuppressants

are powerful medications that suppress the body's immune system.

Immunosuppressive medicines

the most serious complications of this drug therapy: hepatic cirrhosis, interstitial pneumonitis, and severe myelosuppression are quite rare, especially with proper monitoring. Stomatitis and oral ulcers, mild alopecia and hair thinning, GI upset may occur and are related to folic acid antagonism. These side effects can be improved with folic acid supplementation

Methotrexate

is considered the first-line DMARD agent for most patients with rheumatoid arthritis . It has a relatively rapid onset of action at therapeutic doses (6-8 weeks), good efficacy, favorable toxicity profile, ease of administration, and relatively low cost.

Methotrexate (Rheumatrex®, Trexall®)

moa: The anti-inflammatory effects of this drug in rheumatoid arthritis is due to stimulation of adenosine release and adenosine suppresses the inflammatory functions of neutrophils, macrophage/monocytes, dendritic cells and lymphocytes in the pathogenesis of joint inflammation.

Methotrexate (Rheumatrex®, Trexall®)

that inhibits TNF before it can act on its natural receptor to "switch on" the process of inflammation. This effectively blocks the TNF inflammation messenger from recruiting the cells of inflammation.

Tumor Necrosis Factor (TNF) inhibitors

Is an autoimmune disease that causes chronic inflammation of the joints and other areas of the body

rheumatoid arthritis

The underlying mechanism invokes the bodes immune system attacking the joints, this results in inflammation and thickening of the joint capsule; it also affects bone and cartilage

rheumatoid arthritis

also referred to as Disease-Modifying Antirheumatic Drugs (DMARDs)) - These drugs can take several weeks or months to demonstrate a clinical effect and promote disease remission and prevent progressive joint destruction.

slow acting drugs

This is early stage rheumatoid arthritis. This stage involves initial inflammation in the joint capsule and swelling of synovial tissue. This induces the clear symptoms of joint pain, swelling, and stiffness.

stage 1

In the moderate stage of rheumatoid arthritis, the inflammation of synovial tissue becomes severe enough that it causes cartilage damage. In this stage, symptoms of loss of mobility and range of motion become more frequent.

stage 2

The slow acting drugs for RA

- DMARDS - TNF-a inhibitors - Interleukin 1 receptor antagonist - Interleukin 6 inhibitors - T cell activation inhibitors -Immunosuppresants - B cell depletes - JAK inhibitors

Examples of NSAIDS: Prescription (fast acting)

- Indomethacin (Indocin) - Etodolac (Lodine) - Piroxicam (Feldene) - Diclofenac (Voltaren) - Meloxicam (Mobic)

is a biologic medication that blocks T-cell activation. It is used to treat adult patients who have failed treatment with a traditional DMARD medication. It is an intravenous infusion given monthly or a weekly subcutaneous injection.

Abatacept (Orencia)

NSAID class also includes these drugs, which offer anti-inflammatory effects with less risk of stomach irritation and bleeding risk. These drugs were designed to decrease the gastrointestinal risk of NSAIDS, but concerns of possible increases in cardiovascular risk.

COX-2 inhibitors (celecoxib, Celebrex®)

- can be given orally or injected directly into tissues and joints. - They are more potent than NSAIDs in reducing inflammation and in restoring joint mobility and function. - are useful for short periods during severe flares of disease activity or when the disease is not responding to NSAIDs. -However, they can have serious side effects, especially when given in high doses for long periods of time

Corticosteroid medications

These agents have been shown to promote disease remission and prevent progressive joint destruction.

DMARDS

long-term medications mean to slow or alter the progression of rheumatoid arthritis by stopping the immune system from attacking healthy tissue. These drugs protect joints and tissues from permanent damage and gradually reduce daily pain.

DMARDS

have been shown to be beneficial in some short-term studies in rheumatoid arthritis. This suggests that there may be benefits by adding more fish to the diet.

Fish oils, such as in salmon, and omega-3 fatty acids supplements

has also been used in the treatment of malaria. It is used over long periods for the treatment of rheumatoid arthritis. Possible side effects include: upset stomach, skin rashes, muscle weakness, and vision changes.

Hydroxychloroquine (Plaquenil)

contributes to both the local and systemic effects in rheumatoid arthritis . Its multiple effects include - Promotes the recruitment of inflammatory cells at the site of inflammation, - Stimulates the production of metalloproteases, resulting in breakdown of connective tissue - Stimulates the maturation of osteoclasts, which contributes to joint bone destruction.

IL-1

is a pro inflammatory cytokines- excessive production has been found in the synovial fluid and blood of patients with rheumatoid arthritis, and its levels correlate with disease activity and joint destruction

IL-6

Joint pain, such as in the joints of the feet, hands, and knees, Swollen joints Stiff joints Fatigue Joint redness Fever Tender joints, loss of joint function rheumatoid nodules Joint deformity

RA

autoimmune disease in which the body's own immune system attacking the body's joints

RA

can be effective in treating autoimmune diseases like rheumatoid arthritis because it depletes B-cells, which are important cells of inflammation and in the production of abnormal antibodies that are common in these medical conditions. It is used to treat moderate to severely active rheumatoid arthritis in patients who have failed treatment with the TNF-blocking biologics

Rituximab (Rituxan)

is mouse/human recombinant monoclonal antibody that binds to CD20. It was first used to treat lymphoma, a cancer of the lymph nodes.

Rituximab (Rituxan)

is an oral medication is used to treat rheumatoid arthritis in combination with anti-inflammatory medications. it is generally well tolerated Common side effects include rash and upset stomach it should also be avoided by people with known sulfa allergies.

Sulfasalazin (Azulfidine)

contribute to both systemic effects and bone destruction and promotes the destruction of bone by increasing the number of osteoclasts (responsible for breakdown of bone) and decreasing the number of osteoblast (bone formation)

TNF-a

What are the cytokines responsible for inflammation and joint destruction in RA

TNF-a, interleukin 1 and interleukin 6

the first approved biologic medication that blocks interleukin-6 (IL-6), which is a chemical messenger of the inflammation of rheumatoid arthritis. It is an intravenous infusion given monthly or a weekly subcutaneous injection.

Tocilizumab

is the first in a new class of medications used to treat rheumatoid arthritis called JAK inhibitors to treat adults with moderately to severely active rheumatoid arthritis in which methotrexate did not work. Taken by orally twice daily and is considered a "targeted" medication that specifically blocks special enzymes of inflammation in joints (called Janus kinase) within cells.

Tofacitinib (Xeljanz)

Examples of NSAIDS: over the counter (fast acting)

acetylsalicylate (aspirin), Naproxen (Naprosyn) and Ibuprofen (advil, medipren, motrin)

is minimized or avoided in rheumatoid arthritis patients taking methotrexate.

alcohol

Side effects of these drugs include: Stomach upset, Abdominal pain, Ulcers, and even Gastrointestinal bleeding.

aspirin and other NSAIDS

These supplements are used to prevent osteoporosis in patients with rheumatoid arthritis.

calcium and Vitamin D

Side effects include: - Weight gain - Facial puffiness - Thinning of the skin and bone, - Easy bruising - Leg swelling - Cataracts - Risk of infection - Muscle wasting, and destruction of large joints, such as the hips. - Increased blood pressure - Mood swings

corticosteroids

The anti-inflammatory effects of this in dietary turmeric, an ingredient in curry, may be beneficial in reducing symptoms of rheumatoid arthritis

curcumin

A large number of these are activated in the joints of patients with RA; play a fundamental role is the causes of inflammation associated with RA

cytokines

these drugs are short onset of action and are used to reduce pain and inflammation.

fast-acting drugs

given at a dose of 1mg daily does not diminish the efficacy of methotrexate and is routinely given with methotrexate to decrease these side effects.

folic acid

is used as a supplement to prevent side effects of methotrexate treatment of rheumatoid arthritis.

folic acid

autoimmune reactions stimulate these cells to produce multiple inflammatory cytokines in the joints which results in swelling and pain, progressive damage to cartilage and bone and over time contribute to increased cardiovascular morbidity and mortality

macrophages and t cells

The exception is this drug, not associated with serious side effects and can be carefully monitored with blood testing.

methotrexate

caused by mechanical wear and tear on joints.

osteoarthritis

it is considered severe rheumatoid arthritis. Inflammation in the synovium is now destroying not only the cartilage of the joint but the bone as well. Potential symptoms of this stage include increased pain and swelling and a further decrease in mobility and even muscle strength. Physical deformities on the joint may start to develop as well.

stage 3

end stage of rheumatoid arthritis, the inflammatory process ceases and joints stop functioning altogether. Pain, swelling, stiffness and loss of mobility are still the primary symptoms in this stage.

stage 4

The main difference between Rheumatoid Arthritis and Osteoarthritis

the cause behind the joint symptoms

A consultation with a physical and an occupational therapist is recommended early in the course.

true

Because obesity stresses the joints, ideal body weight should be achieved and maintained. Rest, in general, is an important feature of management. When the joints are actively inflamed, vigorous activity should be avoided because of the danger of intensifying joint inflammation or causing traumatic injury to structures weakened by inflammation.

true

On the other hand, patients should be urged to maintain a modest level of activity/exercise to prevent joint laxity and muscular atrophy. The use of walking aids (canes, walkers) are effective means of reducing stress on specific joints.

true

Treatment options for RA include medications, physical and occupational therapy, and surgical intervention.

true