RA & OA

RA: cause

autoimmune response!

-Immune system attacks synovial tissue: produce cytokines which include tumor necrosis factor (TNF)

-periods exacerbation

RA: where effect body?

-symmetric joint stiffness and pain

-symptoms most intense in morning

-joints become swollen; fingers and wrist

RA Drug Therapy: 3 treatment goals

1. Decrease joint inflammation: relieve symptoms + maintain joint function and ROM

2. Decrease systemic involvement

3. Delay progression of disease

RA Drug Therapy: 3 categories of drug

1. NSAIDS: pain and inflammation

2. Corticosteroids: inflammation

3. DIsease-modifying antirheumatic drugs (DMARDs): nonbiologic or biologic

RA and NSAIDS: does NOT…

-does NOT: prevent joint damage, slow disease progression

-helps pain and inflammation

RA and Corticosteroids: use, side effects, advere effects, admin

-pain and inflammation

-short term use versus long term

• oral or injections (but only get 2-3 injections/year)

• DMARDs take couple weeks to get started

Side Effects

-osteoporosis, infection, hyperglcemia, weight gain, peptic ulcer, groth supression, cataracts, adrenal supression

Adverse Side Effects

-hypotension!

-must taper dosage

Admin

-not just for RA, different routes

RA Drug Therapy

-DMARDs (main meds taking!)

• Methotrexate preferred conventional synthetic DMARD

• Hydroxycholorquine

-Biolgoic DMARDs added if methotreate fails

2 types of DMARD

nonbiologic small molecules and biologic antibodies…

Nonbiologic

-chemical

-cheaper

-oral

-adverse drug reactions (bc effect immune)

Biologic

-biological

-expensive

-injection (quicker)

-increase risk for infection

Methotrexate (Rheumatrex)

-many rhematologicts consider 1st choice DMARD

-therapetuic effects develop in 3-6 weeks

-oral or injected

-side effect: rash, upset stomach

-adverse effects: hepatic fibrosis, bone marrow supression, GI ulceration, pneumonities

-commonly used for cancer

TNF Antagonists

most common: Adalimumab (Humira)

-MOA: neturalized TNF

-Side effects: injection site reactions

-Adverse effects: infection

-Black box warning: severe infection and malignancy

DMARDs-combinations and nonpharmacologic: goals + dietary/nonpharmacologic implicaitons

Goal of this strategy

•Attack underlying causes of RA from multiple directions

•Methotrexate usually base with TNF-α inhibitor as first option

Dietary/nonpharmacologic implications

•High in fish oil and certain fatty acids > serve to suppress inflammatory signal

•Food with antioxidant properties (fruits, vegetables)

•Avoid diets rich in meat and proteins

•Eliminate cigarette smoking

OA is not…

autoimmune! just one joint

OA: types, predisposing facotrs, treatment

Two types:

-Primary OA= no apparent reason for onset

-Secondary OA= known factor (e.g. trauma) precipitates onset

Predisposing factors

-obesity, genetic susceptibility, joint vulnerability (malalignment, weakness, etc.)

Treatment

-Treatment is focused on nonpharmacological measures

-PT, weight loss, joint replacement

-Drugs are used for pain management & to maintain an active lifestyle

APTA Knee OA Management

No support

-Glucosamine or chondroitin

-Hyaluronic acid for long-term management (4-26 weeks) of symptomatic knee osteoarthritis 

Strong supporting evidence

-Oral and topical selective (COX-2 inhibitors)

• Topical NSAIDs [Strong support] - safer and better tolerated compared with oral NSAIDs [Support]. *topical > oral

• COX-2 inhibitors had a lower % of GI adverse events compared with non-selective NSAIDS

-Non-selective NSAIDS 

Inconclusive evidence

-Intra-articular corticosteroid injections are effective for short-term (up to 1 month) pain-relief.

-Platelet-rich plasma injections 

-Acetaminophen, opioids, or pain patches 

American College of RA: management guidelines

-received well: exercise, weight loss, topical NSAID

-agonsit: TENS, other meds

Kahoot

-not a goal of RA

-true of RA

-increase sedation to decrease symptoms

-corticosteroids decrease inflammation