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Rheumatoid Arthritis Treatment options PowerPoint Presentation

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Description : This medical presentation titled "Rheumatoid Arthritis: Treatment options" talks about rheumatoid arthritis which is a chronic systemic autoimmune inflammatory disease that causes aggressive inflammatory changes in the synovium. It causes joint pain, stiffness, swelling and ultimately may lead to joint damage and functional debility. The presentation talks about various treatments availanble for rheumatoid arthritis.

Tags : Rheumatoid Arthritis, Treatment options, chronic systemic autoimmune inflammatory disease, aggressive inflammatory changes, synovium, joint pain, stiffness, swelling, joint damage, functional debility

Published on : Apr 26, 2021 | Views : 2216 | Downloads : 16

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Slide 1-

Rheumatoid Arthritis:Treatment options Chacko J. Alappatt, M.D., F.A.C.P., F.A.C.R
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Rheumatoid Arthritis (RA) Fast facts PREVALENCE : An estimated 1.5 million adults in the United States have rheumatoid arthritis. Affects 0.5-1.0% of population Women are two to three times as likely to be affected as men. Rheumatoid arthritis (RA) is an inflammatory systemic disease, with the hallmark of symmetric peripheral polyarthritis.
Slide 3-

What is Rheumatoid Arthritis (RA)? A chronic systemic autoimmune inflammatory disease that causes aggressive inflammatory changes in the synovium which causes joint pain/stiffness/swelling and ultimately leads to joint damage and functional debility
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Rheumatoid Arthritis (RA)
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Rheumatoid Arthritis- Joint Distribution
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Rheumatoid Factor AUTOANTIBODIES (OFTEN IgM) WITH SPECIFICITY FOR THE Fc PORTION OF THE IgG MOLECULE MAJOR LABORATORY HALLMARK OF RA ASSOCIATED WITH MORE SEVERE DISEASE, EXTRAARTICULAR MANIFESTATIONS NOT SPECIFIC FOR RA
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Cyclic Citrullinated Peptide (CCP) Ab Sensitivity/Specificity for RA: 80%/96-98% Can be detected up to 10 years prior to onset of symptoms Marker for more aggressive disease Readily available (yet not part of ‘arthritis panels’??)
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Rheumatoid Arthritis –ACR Criteria (1987)  4 OF THE FOLLOWING CRITERIA MUST BE PRESENT IN ORDER TO CLASSIFY AS RA: AM STIFFNESS > 1 HR (≥6 weeks) ARTHRITIS IN > 3 JOINTS (≥6 weeks) ARTHRITIS IN PIPS, MCP, WRISTS (≥6 weeks) SYMMETRIC ARTHRITIS (≥6 weeks) POSITIVE RHEUMATOID FACTOR RHEUMATOID NODULES RADIOGRAPHIC CHANGES: PERIARTICULAR OSTEOPENIA EROSIONS
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RA 2010 Diagnostic Criteria
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Etiology of Rheumatoid Arthritis (RA)
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Hereditary predisposition/environmental trigger Autoimmunity Release inflammatory mediators/cytokines Chronic inflammation of the synovial tissue lining joint capsule Proliferation of the synovium into Pannus Pannus invades cartilage and bone surface producing bone erosion Joint Destruction
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Rheumatoid Arthritis Treatment Goals RELIEVE PAIN, SWELLING, FATIGUE IMPROVE JOINT FUNCTION STOP JOINT DAMAGE PREVENT DISABILITY AND DISEASE- RELATED MORBIDITY MINIMIZE/AVOID ADVERSE EVENTS (MONITOR FOR TOXICITY)
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DMARD: Disease Modifying Anti-Rheumatic Drug
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RA Management in 2017 Goal Processes Tools Zero Disease Activity Remission Traditional DMARDs Biologic DMARDs Combination Therapy Early Treatment Aggressive Treatment Monitor Disease Activity
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Non Biologic small molecule DMARDs Hydroxychloroquine Sulfasalazine Leflunomide Methotrexate (Prednisone/Corticosteroid)
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Biologic Response Modifier Drugs
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Important information: Biologics Typically given by SC injection or infusion Complex molecules made in living cells All modify the immune system; can predispose to infection ? Associated with Malignancy Before initiation, screen for latent infections: Tuburculosis, Hepatitis, HIV live vaccines (Zoster) contraindicated; vaccinate prior to initiation
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Important information: Biologics Most common adverse events: injection site reactions, “nasopharyngitis”, headache Abatacept (Orencia) : caution in COPD Combining two biologics: Not recommended Tofacitinib citrate (Xeljanz): watch Lipids Rituximab (Rituxan): PML and use in malignancy Other: CHF, Bowel perforations, Demyelination, “Lupus like Syndrome”
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Tumor Necrosis Factor Antagonists Infliximab (Remicade) Etanercept (Enbrel) Certolizumab (Cimzia) Golimumab (Simponi) Adalimumab (Humira)
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B-Cell Depletion: Rituximab
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Co-stimulation Inhibitor: Abatacept
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Tocilizumab (Actemra): IL-6 (-)
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Jak inhibition: Tofacitinib (Xeljanz)
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Biosimilars: the new Horizon
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The new Horizon: Biosimilars 4/2016: FDA approves Inflectra (Pfizer), biosimilar for Infliximab (Remicade-Jansen) 8/2016: FDA approves Erelzi (Sandoz), biosimilar for Etanercept (Enbrel-Amgen) 9/2016: FDA approves Amjevita (Amgen), biosimilar for Adalimumab (Humira-Abbvie)
Slide 26-

Your patient John, a 51 year old male, who takes Enbrel for his RA is interested in the Zoster vaccination. You advise Good idea, arrange for vaccination He is not a candidate for vaccination Can get vaccination but has to be off Enbrel for a month before and after vaccination Good idea but he will need to wait until age 60
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Your patient Alexandra, a 58 year old female with Rheumatoid Arthritis who takes Methotrexate (MTX) and Enbrel develops a culture positive (E. Coli) urinary tract infection. You advise Treat with Bactrim; continue MTX; hold Enbrel Treat with Cipro; hold Enbrel Treat with Cipro; continue MTX and Enbrel
Slide 28-

Which of the following Rheumatoid Arthritis medications can increase serum cholesterol? Etanercept (Enbrel) Tofacitinib (Xeljanz) Tolcilizumab (Actemra) Rituximab (Rituxan)