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Rheumatoid Arthritis - Coggle Diagram
Rheumatoid Arthritis
Pathophysiology
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Cell proliferation, inflammation, destruction of tissue
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Prevalence: 0.24- 1% of the population, primarily women (twice as common for women than men)
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Treatment
Pharmacologic
First-line Agents
Methotrexate
Monitoring: CBC, ALTs, ASTs, renal function
Warnings/Contraindications: alcoholism, alcoholic liver disease or other chronic liver disease, immunodeficiency, and preexisting hematologic disorders, such as leukopenia and thrombocytopenia
Regimen: ORAL: 10-15mg once weekly, increased by 5mg every 2-4 weeks to a maximum of 20-30mg once weekly. consider concomitant folic acid at 5mg per week.
Interactions: DRUG: alcohol, acitretin, ciprofloxacin FOOD: peak serum levels decreased if taken with food
ADRs: deep vein and arterial thrombosis, infection, pulmonary complications, gastrointestinal problems, hematologic changes, hepatic toxicities
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PK/PD (adults): oral is highly absorbed, ~60% bioavailability, ~50% protein binding, 80-90% renally excreted
Hydroxycholroquine
Monitoring: CBC at baseline and periodically, liver and renal funcion, blood glucose, Eye exam at baseline, monitor for QTc prolongation
Warning: can cause retinopathy, cardiomyopathy, bone marrow suppression, dermatitis, severe hypoglycemia
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contraindication: hypersensitivity, long term therapy in children, retinal changes attributable to 4-aminoquinoline compounds
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MOA: antimalarial action and chronic RA benefit, exact MOA is unknown
Sulfasalazine
Special populations: Slow acetylators have a prolonged half life, not recommended for children
Warnings: Sulfa drug, CNS effects, blood dyscrasias
ADRs: skin rash, nausea, headache
Regimen:
Initial: 3 to 4 g/day in divided doses at ≤8-hour intervals; may initiate therapy with 1 to 2 g/day to reduce GI intolerance. Doses >4 g/day can increase the risk of toxicity.
Maintenance: 2 g/day in divided doses at ≤8-hour intervals when endoscopic exam confirms improvement
MOA: unknown, thought to modulate chemical mediators of inflammatory respnse
Monitoring: CBC with differential Q 3 months, urinalysis and renal/liver function tests; stool frequency; signs of infection, dermatologic toxicity, or hypersensitivity reactions.
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Clinical Presentation
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Joint Involvement
Hands, wrists, ankles and feet most commonly affected (often bilaterally)
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Goals: Pain relief, protection of remaining structures, maintenance of function, relief from fatigue and weakness
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