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Rheumatoid Arthritis:
- An autoimmune, inflammatory disorder
- Joints are destroyed by autoimmune process
- Immune system attacks synovial tissue
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Goals of Treatment for Rheumatoid Arthritis:
- 1. Relieve symptoms
- 2. Maintain joint function
- 3. Minimize systemic involvement
- 4. Delay disease progression
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Treatment Types for Rheumatoid Arthritis:
- Non-drug Measures:
- -Physical therapy, exercise, surgery
- Drug Therapy:
- -Nonsteroidal anti-inflammatory drugs
- -Glucocorticoids
- -Disease-modifying antirheumatic drugs
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NSAIDS (Non-steroidal anti-inflammatory drugs)
for Rheumatoid Arthritis
- rapid relief of symtpoms
- does not prevent joint damage
- do not slow disease progression
- safer then others
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DMARDs (Disease-modifying antirheumatic drugs)
for Rheumatoid Arthritis:
- Provide rapid relief of symptoms
- Slows the progression
- Close monitoring required to prevent toxicity
- Short courses of drugs rather long terms
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DMARDs are subdivided:
- Nonbiologic- Small molecules/traditional chemical techniques
- Biologic- Large molecules/ recombinant DNA technology
- -very expensive
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What do DMARDs do for Rheumatoid Arthritis:
- Decrease inflammation
- Immunosuppressant
- Risk of serious infections!
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Glucocorticoids for Rheumatoid Arthritis:
- Powerful anti-inflammatory
- May slow progression of RA
- Long term use can cause toxicity
- Osteoporosis
- Gastric Ulceration
- Adrenal suppression
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Treatment for Rheumatoid Arthritis:
- DMARDs within three months
- NSAIDs are needed until DMARDs take effect
- Glucocorticoids- short courses if needed until DMARDs take effect
- **If joint destruction continues during treatment:
- a second DMARD may be added or substituted
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Gout:
- Recurrent inflammatory disorder (severe pain)
- Hyperuricemia
- Sodium urate crystalizes in synovial space
- -this sets off inflammatory response
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Treatment for Gout:
- NSAIDs most common
- -Glucocorticoids are acceptable
- Drugs for Hyperuricemia:
- -Drugs that decrease production
- -Drugs that increase secretion
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Hyperuricemia=
Uric Acid- above 7 in men, above 6 in women
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Drugs For Hyperuricemia:
- Used on patients with frequent attacks (3 or more/yr)
- Allopurinol and Febuxostat
- Probenecid and Sulfinpyrazone
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Allopurinol and Febuxostat:
Decrease production of uric acid
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Probenecid and Sulfinpyrazone:
Increase excretion of uric acid
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Goal of both drugs:
(Allopurinol and Febuxostat vs. Probenecid and Sulfinpyrazone)
To obtain uric acid level of 7 or below ion men and 6 or below in women
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What regulates Calcium
- Parathyroid hormone
- Vitamin D
- Calcitonin
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Bisphosphonates:
- Used to treat Osteoporosis, Glucocorticoid-induced osteo and Paget's disease
- They suppress/stop resorption of bone
- Not absorbed well orally (Don't take with FOOD!!)
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Raloxifene-Evista
- Selective estrogen receptor modulators (SERMs)
- Exerts estrogenic effects
- Preserves BMD (Bone Mineral Density)
- Lowers cholesterhol
- Helps to prevent breast and endometrium cancers (used as a prophylactic drug)
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Teriparatide- Forteo
- A form of parathyroid hormone
- Only drug for osteoporosis that INCREASES BONE FORMATION
- All others decrease bone resorption
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