Rheumatoid Arthritis

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Rheumatoid Arthritis
2012-02-19 19:13:31
Regis University

Rheumatoid Arthritis
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  1. Interleukin-1 (IL-1)
    • promotes the activation of monocytes and macrophages
    • Stimulates the release of cartilage matrix metalloproteinases from fibroblasts and chondrocytes
    • metalloproteinases mediate the destruction of articular cartilage
  2. Interleukin-4 (IL-4)
    • Produced by CD4+ type 2 helper cells and helps drive the differentiation and growth of B cells
    • Inhibits the activation of type 1 helper T cells and decreses the production of IL-1 and TNF-α
  3. Interleukin-6 (IL-6)
    • produced by T cells, macrophages, monocytes, and synovial fibroblasts
    • induces profliferation of synovial fibroblasts
  4. Interleukin-10 (IL-10)
    • anti-inflammatory cyokine produced by macrophages, monocytes, and both T and B cells
    • dampens the inflammatory response by inhibiting production of IL-1 and TNF-α as well as proliferation of T cells
  5. 4 Major Criteras for RA
    • Joint involvement: (0-5 pts)
    • assess the number and location of joints involved
    • Serology: (0-3 pts)
    • RF (rheumatoid factor) and ACPA (anticyclic citrullinated peptide antibody)
    • Acute-phase reactants positive: (0-1 pts)
    • ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein)
    • Duration of symptoms: (0-1 pts)
    • less than or more than 6 week duration
  6. Clinical presentatin of RA
    • Symptoms: RA
    • joint pain and stiffness >6 weeks duration
    • experience fatigue, weakness low-grade fever, loss of appetite
    • muscle pain and afternoon fatigue
    • joint deformity seen late in disease
    • Signs: RA
    • tenderness w/warmth and swelling over affected joints involving hands and feet
    • distribution of joint involvement is symmetrical
    • rheumatoid nodules may be present
  7. Summary of Biologic Agents
    • NOT first line therapy for RA
    • use w/ methotrexate
    • variable response
    • TB testing prior to use
    • No live vaccines