SlideShare una empresa de Scribd logo
1 de 25
Descargar para leer sin conexión
What is Arthritis?
 There are 127 different kinds of
arthritis!
 Osteoarthritis: progressive
degeneration of joint cartilage.
Minor degree of inflammation.

 Rheumatoid arthritis: Severe
inflammation that involves many
joints and moves beyond
musculoskeletal system.
 Gout: Very painful form of
arthritis characterized by the
formation of uric acid crystals
and severe inflammation.
Rheumatoid arthritisChronic progressive, autoimmune disease in
which there is joint inflammation, synovial
proliferation, and destruction (crippling) of
articular cartilages with waxing and waning
course.
INFLAMMATORY MEDIATORS-

Cytokines
Interleukin 1
TNF-alpha
Autoimmune
IgM activates complements and release infl. Mediators
Neutrophil infiltration
Release of Lysosomal enzymes

PGs

Damage to cartilage, bone errosion

vasodilatation
edema & pain
RHEUMATOID ARTHRITIS (VK)
RHEUMATOID ARTHRITIS (VK)
RHEUMATOID ARTHRITIS (VK)
• Diagnosis
–

–
–
•

Early diagnosis is the first step to easy control
History
Physical examination

Findings
1.Morning stiffness >1hour
2.Symetrical joint swelling for 6 weeks.
3.Swelling in 3 or more joint areas lasting for
6 weeks or more.
4.Rheumatoid nodule.
5.Positve RF.
6.Radiographic erosions.
The treatment approach:
1. Aims to reduce & possibly prevent damage to the joints & other
organs.
2. Relief of pain –primary aim.
3. Rx of pathology-

Arrest of disease process
- Modification of disease process
-

Nonpharmacological therapy:
o Traditional physical therapy includes-heat & cold therapy
o Motion exercises, Aerobic exercise with muscle strength.

Pharmacological therapy:
o NSAIDs
o DISEASE MODIFYING ANTIRHEUMATIC DRUGS
[DMARDs]
o Adjuvant: GLUCOCORTICOIDS
NSAIDs• Used in first; they afford symptomatic relief of
pain, swelling, morning stiffness, immobility.
• Donot arrest disease process.






Diclofenac sodium (75-100mg BD)
Ibuprofen
(200-400mg TDS)
Naproxen
(500mg single dose)
Aspirin
(3-5g/day)
Indomethacin

Special precautions
- Peptic

ulcer
-Bleeding disorder
DISEASE MODIFYING ANTIRHEUMATIC
DRUGS [DMARDs]
• Suppress the rheumatoid process i.e.
arrest the basic process of joint
destruction
• Bring about remission.
• Also called as SAARDs

»Contd.,
DMARDs
•

1.Methotrexate (Mtx.)

•

2. Agents used in mild disease or in combination with MTX.
•

•
•

•

3.Traditional DMARDs -(limited used currently)
•

•
•

•

Gold salts (Aurothiomalate sodium)…..X
d-Penicillamine………………………..X
Azathioprine

4. Biological agents
•

•
•
•

Hydroxychloroquine
Sulfasalazine
Minocycline

Cyclosporine
Infliximab

Leflunomide

Methoterxate, Azathioprine, Cyclosporine are IMMUNOSUPPRESANT
Leflunomide IMMUNO MODULATOR
METHOTREXATE (Mtx)
• An anti metabolite (inhibit dihydrofolate reductase)
inhibits folic acid synthesis.
• 1st line DMARD at present
• RA-Primary MOA is anti-inflammatory rather than
antimetabolites -Inhibit cytokine production, cell
mediated immune reaction, chemotaxis.
• Dose-7.5-10 mg oral weekly.
• Onset of symptom relief is relatively rapid –
preferred for initial treatment
»Contd.,
• PK- Oral BV of Mtx is variable, may effected by food
- Excretions is dec. in renal disease pt.

• S/E-GIT distress (parenteral therapy effective to reduce
30mg/wk. i.v, less expensive.)
-Oral ulcer
-Hair loss
-Pneumonia (dec. By use of FA)
-Dose dependent progressive liver damage
Hydroxychloroquine
• Antimalarial
• Antirheumatic-found to induce remission in 50% patients.
• MOA-inhibit inflammatory cells: monocytes interleukins,
B lymphocytes.
• RA- long periods
• Dose-200mg bd
• Combined with MTX.
• S/ERetinal damage
Corneal opacities
Neuropathy, Myopathy
Rash
Graying of hairs
Irritable bowel syndrome
Sulfasalazine
• Combination of sulphapyridine and 5 aminosalicylic
acid
• Inhibits generation of superoxides and cytokines by
the inflammatory cells.
• Efficacy is equal to chloroquine.
• 1-3g/day (3divided dose)
• Few adverse effect / good alternative for Mtx

Minocycline
• Group III broad spectrum antibiotic inhibit
arthritic inflammation.
• Used in com. With MTX.
Gold salts (Aurothiomalate sodium)
• Introduced in 1929.
• Gold is most effective agent for arresting
rheumatic process and preventing
involvement of additional joints.
• It reduce chemotaxis, phagocytosis,
macrophages and lysosomal activity and
inhibit cell mediated immunity
• Benefit - 4-6wks
• Starting dose10mg im/wk gradually inc. to
50mg/im/wk up to 1g.then maintain
50mg /im/ for few months.

»Contd.,
• PK:-Gold is heavily bound to plasma and
tissue proteins, specially in kidney, stay in
the body for years
• Toxicity:– Vasodilatation, postural hypotension
– Dermtitis, pruritic rash,
– Albuminuria
– Hepatitis, peripheral neuritis, pulmonary
fibrosis
– Eosinophilia , bone marrow suppression
D-Penicillamine
• Copper chelating agent
• Gold compound like action but less
efficacious.
• Toxicity is similar like gold
• Toxicity: Rash, Proteinurea, Kidney damage,
bone marrow depression
• Dose: Start with 125-250mg OD, then 250mg
BD.
Azathioprine
• Purine antimetabolite
• Potent suppressant of cell mediated
immunity
• Affect differentiation and function of T-cells
and natural killer cells
• Remission in RA is less but some cases
not responding to gold may respond to it.
• Given along with corticosteroid
• Dose: 2.5-5mg/kg/day
4.Biological agents
Infliximab• Chimeric IgG1-kappa monoclonal antibody
• Anti TNF antibodies
• Binds to soluble, bound both the forms of TNF
and thus causes dose dependent neutralization
of TNF alpha.
• Useful in patients resistant to DMARDs and
Methotrexate.
• Given IV, half life 8-12 days.
• A/E: N,V,H and coughing.
other use-Crohn’s disease.
»Contd.,
Entanercept
• Dimer consisting of TNF receptor joined to Fc
domain of human IgG…..binds to TNFα & β.
• Given by SC route thrice a wk.
• Effective in juvenile RA where Infliximab is found
ineffective.

Levamisole
• Antihelminthic in a dose of 150 mg.
• MOA-unknown
• A/E- Agranulocytosis
Leflunomide:
• Recently introduced immunomodulator
• It inhibits proliferation of activated lymphocytes in
patients with active RA.
• Arthritic symptoms are suppressed and radiological
progression is retarded
• It is rapidly converted in the body to active
metabolite, which inhibits dihydroorotate
dehydrogenase and pyrimidine synthesis in actively
growing cells.

»Contd.,
• It is alternative for MTX or Sulfasalazine
• Dose: Loading dose of 100mg daily for
3days followed by 20mg OD (t1/2 2 wks)
• S/E: Elevation of liver enzymes, renal
impairment and teratogenic effect

23
• Adverse effects:- D, H, N, rashes, loss of
hair, thrombocytopenia, chest infection
• C/I:children, pregnant and lactating
women.
Corticosteriods
• Potent immunosuppressants and
antiinflammatory drugs.
• Inducted at any stage in RA.
• They do not arrest the rheumatoid process nor
prevent erosions.
• Long term use of corticosteroid carries serious
disadvantages.. Low dose 5-10mg
• High dose employed over short periods in cases
with severe systemic manifestations.

Más contenido relacionado

La actualidad más candente

La actualidad más candente (20)

Rheumatoid arthritis pdf
Rheumatoid arthritis pdfRheumatoid arthritis pdf
Rheumatoid arthritis pdf
 
Systemic steroids
Systemic steroidsSystemic steroids
Systemic steroids
 
Antitubercular Drug
Antitubercular Drug Antitubercular Drug
Antitubercular Drug
 
Chemotherapy of maleria
Chemotherapy of maleriaChemotherapy of maleria
Chemotherapy of maleria
 
Drug treatment of rheumatoid arthritis
Drug treatment of rheumatoid arthritisDrug treatment of rheumatoid arthritis
Drug treatment of rheumatoid arthritis
 
Eczema dermatitis homeopathy treatment
Eczema dermatitis homeopathy treatmentEczema dermatitis homeopathy treatment
Eczema dermatitis homeopathy treatment
 
SYSTEMIC LUPUS ERYTHEMATOSUS
SYSTEMIC LUPUS ERYTHEMATOSUSSYSTEMIC LUPUS ERYTHEMATOSUS
SYSTEMIC LUPUS ERYTHEMATOSUS
 
Drugs for leprosy
Drugs for leprosyDrugs for leprosy
Drugs for leprosy
 
Rheumatoid arthritis
Rheumatoid arthritisRheumatoid arthritis
Rheumatoid arthritis
 
Drug Treatment Of Gout
Drug Treatment Of GoutDrug Treatment Of Gout
Drug Treatment Of Gout
 
anti-amoebic drugs
anti-amoebic drugs anti-amoebic drugs
anti-amoebic drugs
 
Osteoarthritis Management R Gunadi
Osteoarthritis Management R GunadiOsteoarthritis Management R Gunadi
Osteoarthritis Management R Gunadi
 
Toxicity of pesticides
Toxicity of pesticidesToxicity of pesticides
Toxicity of pesticides
 
NSAIDs
NSAIDsNSAIDs
NSAIDs
 
Drug allergy
Drug allergyDrug allergy
Drug allergy
 
Quinolones
QuinolonesQuinolones
Quinolones
 
Linezolid
LinezolidLinezolid
Linezolid
 
Psoriatic arthritis
Psoriatic arthritis Psoriatic arthritis
Psoriatic arthritis
 
Drugs used in treatment of gout
Drugs used in treatment of goutDrugs used in treatment of gout
Drugs used in treatment of gout
 
Pharmacotherapy of scabies
Pharmacotherapy of scabiesPharmacotherapy of scabies
Pharmacotherapy of scabies
 

Similar a RHEUMATOID ARTHRITIS (VK)

Rheumatoid arthritis
Rheumatoid arthritisRheumatoid arthritis
Rheumatoid arthritisVijay Rathod
 
Rheumatoid arthritis and gout.ppt
Rheumatoid arthritis and gout.pptRheumatoid arthritis and gout.ppt
Rheumatoid arthritis and gout.pptAbhinav kanwal
 
Non steroidal immunosupressants
Non steroidal immunosupressantsNon steroidal immunosupressants
Non steroidal immunosupressantsShruti Laddha
 
IMSK-_Rheumatoid_Arthritis.pdf
IMSK-_Rheumatoid_Arthritis.pdfIMSK-_Rheumatoid_Arthritis.pdf
IMSK-_Rheumatoid_Arthritis.pdfSanjayaManiDixit
 
Role of immunomodulators in oral diseases
Role of immunomodulators in oral diseasesRole of immunomodulators in oral diseases
Role of immunomodulators in oral diseasesNikhil C Panicker
 
Management of rheumatoid arthritis
Management of rheumatoid arthritisManagement of rheumatoid arthritis
Management of rheumatoid arthritisDr. Irfan Ahmad Khan
 
Immunosuppressives in dermatology tut..pptx
Immunosuppressives in dermatology tut..pptxImmunosuppressives in dermatology tut..pptx
Immunosuppressives in dermatology tut..pptxDeepikaKothari9
 
Immunosuppressives in dermatology tut..pptx
Immunosuppressives in dermatology tut..pptxImmunosuppressives in dermatology tut..pptx
Immunosuppressives in dermatology tut..pptxDeepikaKothari9
 
Biological therapy in rheumatic diseases
Biological therapy in rheumatic diseasesBiological therapy in rheumatic diseases
Biological therapy in rheumatic diseasesSamar Tharwat
 
immunosuppressive drugs in dermatology
immunosuppressive drugs in dermatologyimmunosuppressive drugs in dermatology
immunosuppressive drugs in dermatologysiva subramanian
 
seminar-immunosuppressivedrugsindermatology-171225050613.pdf
seminar-immunosuppressivedrugsindermatology-171225050613.pdfseminar-immunosuppressivedrugsindermatology-171225050613.pdf
seminar-immunosuppressivedrugsindermatology-171225050613.pdfAbdiIsaq1
 
Inflammatory Bowel disease ankita
Inflammatory Bowel disease ankitaInflammatory Bowel disease ankita
Inflammatory Bowel disease ankitaankitamishra1402
 
Drugs used in uveitis capt ferdous
Drugs used in uveitis  capt ferdousDrugs used in uveitis  capt ferdous
Drugs used in uveitis capt ferdousFerdous Rafy
 
Immunopharmacology
ImmunopharmacologyImmunopharmacology
ImmunopharmacologyNaser Tadvi
 

Similar a RHEUMATOID ARTHRITIS (VK) (20)

Antirheumatoid drugs
Antirheumatoid drugsAntirheumatoid drugs
Antirheumatoid drugs
 
Rheumatoid arthritis
Rheumatoid arthritisRheumatoid arthritis
Rheumatoid arthritis
 
Rheumatoid arthritis and gout.ppt
Rheumatoid arthritis and gout.pptRheumatoid arthritis and gout.ppt
Rheumatoid arthritis and gout.ppt
 
Non steroidal immunosupressants
Non steroidal immunosupressantsNon steroidal immunosupressants
Non steroidal immunosupressants
 
IMSK-_Rheumatoid_Arthritis.pdf
IMSK-_Rheumatoid_Arthritis.pdfIMSK-_Rheumatoid_Arthritis.pdf
IMSK-_Rheumatoid_Arthritis.pdf
 
Antifungal agents
Antifungal agentsAntifungal agents
Antifungal agents
 
Role of immunomodulators in oral diseases
Role of immunomodulators in oral diseasesRole of immunomodulators in oral diseases
Role of immunomodulators in oral diseases
 
Management of rheumatoid arthritis
Management of rheumatoid arthritisManagement of rheumatoid arthritis
Management of rheumatoid arthritis
 
Immunosuppressives in dermatology tut..pptx
Immunosuppressives in dermatology tut..pptxImmunosuppressives in dermatology tut..pptx
Immunosuppressives in dermatology tut..pptx
 
Immunosuppressives in dermatology tut..pptx
Immunosuppressives in dermatology tut..pptxImmunosuppressives in dermatology tut..pptx
Immunosuppressives in dermatology tut..pptx
 
Biological therapy in rheumatic diseases
Biological therapy in rheumatic diseasesBiological therapy in rheumatic diseases
Biological therapy in rheumatic diseases
 
Antimycobacterial agents
Antimycobacterial agentsAntimycobacterial agents
Antimycobacterial agents
 
immunosuppressive drugs in dermatology
immunosuppressive drugs in dermatologyimmunosuppressive drugs in dermatology
immunosuppressive drugs in dermatology
 
seminar-immunosuppressivedrugsindermatology-171225050613.pdf
seminar-immunosuppressivedrugsindermatology-171225050613.pdfseminar-immunosuppressivedrugsindermatology-171225050613.pdf
seminar-immunosuppressivedrugsindermatology-171225050613.pdf
 
Management of Rheumatoid Arthritis
Management of Rheumatoid ArthritisManagement of Rheumatoid Arthritis
Management of Rheumatoid Arthritis
 
Inflammatory Bowel disease ankita
Inflammatory Bowel disease ankitaInflammatory Bowel disease ankita
Inflammatory Bowel disease ankita
 
Host modulation therapy
Host modulation therapyHost modulation therapy
Host modulation therapy
 
Antifungal agents
Antifungal agentsAntifungal agents
Antifungal agents
 
Drugs used in uveitis capt ferdous
Drugs used in uveitis  capt ferdousDrugs used in uveitis  capt ferdous
Drugs used in uveitis capt ferdous
 
Immunopharmacology
ImmunopharmacologyImmunopharmacology
Immunopharmacology
 

Más de Dr. Abhavathi Vijay Kumar (20)

Immunomodulators(VK)
Immunomodulators(VK)Immunomodulators(VK)
Immunomodulators(VK)
 
Adrenergic drugs (VK)
Adrenergic drugs (VK)Adrenergic drugs (VK)
Adrenergic drugs (VK)
 
Antianginal drugs (VK)
Antianginal drugs (VK)Antianginal drugs (VK)
Antianginal drugs (VK)
 
Sulfonamides (VK)
Sulfonamides (VK)Sulfonamides (VK)
Sulfonamides (VK)
 
Penicillins (VK)
Penicillins (VK)Penicillins (VK)
Penicillins (VK)
 
Opioid analgesics (VK)
Opioid analgesics (VK)Opioid analgesics (VK)
Opioid analgesics (VK)
 
NSAIDs (VK)
NSAIDs (VK)NSAIDs (VK)
NSAIDs (VK)
 
Migraine (VK)
Migraine (VK)Migraine (VK)
Migraine (VK)
 
Local anesthetics (VK)
Local anesthetics (VK)Local anesthetics (VK)
Local anesthetics (VK)
 
General anesthetics(VK)
General anesthetics(VK)General anesthetics(VK)
General anesthetics(VK)
 
Excretion of drug (VK)
Excretion of drug (VK)Excretion of drug (VK)
Excretion of drug (VK)
 
Emetics and antiemetics(VK)
Emetics and antiemetics(VK)Emetics and antiemetics(VK)
Emetics and antiemetics(VK)
 
Cough (VK)
Cough (VK)Cough (VK)
Cough (VK)
 
Chelating agents (VK)
Chelating agents (VK)Chelating agents (VK)
Chelating agents (VK)
 
Bipolar Disorder (VK)
Bipolar Disorder (VK)Bipolar Disorder (VK)
Bipolar Disorder (VK)
 
Blood (VK)
Blood (VK)Blood (VK)
Blood (VK)
 
Antiplatelet drugs (VK)
Antiplatelet drugs (VK)Antiplatelet drugs (VK)
Antiplatelet drugs (VK)
 
Anticoagulants (VK)
Anticoagulants (VK)Anticoagulants (VK)
Anticoagulants (VK)
 
Antimalarial drugs (VK)
Antimalarial drugs (VK)Antimalarial drugs (VK)
Antimalarial drugs (VK)
 
Anticholinergics (VK)
Anticholinergics (VK)Anticholinergics (VK)
Anticholinergics (VK)
 

Último

M-2- General Reactions of amino acids.pptx
M-2- General Reactions of amino acids.pptxM-2- General Reactions of amino acids.pptx
M-2- General Reactions of amino acids.pptxDr. Santhosh Kumar. N
 
What is the Future of QuickBooks DeskTop?
What is the Future of QuickBooks DeskTop?What is the Future of QuickBooks DeskTop?
What is the Future of QuickBooks DeskTop?TechSoup
 
Benefits & Challenges of Inclusive Education
Benefits & Challenges of Inclusive EducationBenefits & Challenges of Inclusive Education
Benefits & Challenges of Inclusive EducationMJDuyan
 
In - Vivo and In - Vitro Correlation.pptx
In - Vivo and In - Vitro Correlation.pptxIn - Vivo and In - Vitro Correlation.pptx
In - Vivo and In - Vitro Correlation.pptxAditiChauhan701637
 
How to Use api.constrains ( ) in Odoo 17
How to Use api.constrains ( ) in Odoo 17How to Use api.constrains ( ) in Odoo 17
How to Use api.constrains ( ) in Odoo 17Celine George
 
The Singapore Teaching Practice document
The Singapore Teaching Practice documentThe Singapore Teaching Practice document
The Singapore Teaching Practice documentXsasf Sfdfasd
 
How to Show Error_Warning Messages in Odoo 17
How to Show Error_Warning Messages in Odoo 17How to Show Error_Warning Messages in Odoo 17
How to Show Error_Warning Messages in Odoo 17Celine George
 
Practical Research 1 Lesson 9 Scope and delimitation.pptx
Practical Research 1 Lesson 9 Scope and delimitation.pptxPractical Research 1 Lesson 9 Scope and delimitation.pptx
Practical Research 1 Lesson 9 Scope and delimitation.pptxKatherine Villaluna
 
Ultra structure and life cycle of Plasmodium.pptx
Ultra structure and life cycle of Plasmodium.pptxUltra structure and life cycle of Plasmodium.pptx
Ultra structure and life cycle of Plasmodium.pptxDr. Asif Anas
 
Philosophy of Education and Educational Philosophy
Philosophy of Education  and Educational PhilosophyPhilosophy of Education  and Educational Philosophy
Philosophy of Education and Educational PhilosophyShuvankar Madhu
 
Practical Research 1: Lesson 8 Writing the Thesis Statement.pptx
Practical Research 1: Lesson 8 Writing the Thesis Statement.pptxPractical Research 1: Lesson 8 Writing the Thesis Statement.pptx
Practical Research 1: Lesson 8 Writing the Thesis Statement.pptxKatherine Villaluna
 
Patterns of Written Texts Across Disciplines.pptx
Patterns of Written Texts Across Disciplines.pptxPatterns of Written Texts Across Disciplines.pptx
Patterns of Written Texts Across Disciplines.pptxMYDA ANGELICA SUAN
 
Human-AI Co-Creation of Worked Examples for Programming Classes
Human-AI Co-Creation of Worked Examples for Programming ClassesHuman-AI Co-Creation of Worked Examples for Programming Classes
Human-AI Co-Creation of Worked Examples for Programming ClassesMohammad Hassany
 
Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.EnglishCEIPdeSigeiro
 
3.21.24 The Origins of Black Power.pptx
3.21.24  The Origins of Black Power.pptx3.21.24  The Origins of Black Power.pptx
3.21.24 The Origins of Black Power.pptxmary850239
 
How to Add Existing Field in One2Many Tree View in Odoo 17
How to Add Existing Field in One2Many Tree View in Odoo 17How to Add Existing Field in One2Many Tree View in Odoo 17
How to Add Existing Field in One2Many Tree View in Odoo 17Celine George
 
The basics of sentences session 10pptx.pptx
The basics of sentences session 10pptx.pptxThe basics of sentences session 10pptx.pptx
The basics of sentences session 10pptx.pptxheathfieldcps1
 
Quality Assurance_GOOD LABORATORY PRACTICE
Quality Assurance_GOOD LABORATORY PRACTICEQuality Assurance_GOOD LABORATORY PRACTICE
Quality Assurance_GOOD LABORATORY PRACTICESayali Powar
 

Último (20)

M-2- General Reactions of amino acids.pptx
M-2- General Reactions of amino acids.pptxM-2- General Reactions of amino acids.pptx
M-2- General Reactions of amino acids.pptx
 
What is the Future of QuickBooks DeskTop?
What is the Future of QuickBooks DeskTop?What is the Future of QuickBooks DeskTop?
What is the Future of QuickBooks DeskTop?
 
Benefits & Challenges of Inclusive Education
Benefits & Challenges of Inclusive EducationBenefits & Challenges of Inclusive Education
Benefits & Challenges of Inclusive Education
 
In - Vivo and In - Vitro Correlation.pptx
In - Vivo and In - Vitro Correlation.pptxIn - Vivo and In - Vitro Correlation.pptx
In - Vivo and In - Vitro Correlation.pptx
 
How to Use api.constrains ( ) in Odoo 17
How to Use api.constrains ( ) in Odoo 17How to Use api.constrains ( ) in Odoo 17
How to Use api.constrains ( ) in Odoo 17
 
The Singapore Teaching Practice document
The Singapore Teaching Practice documentThe Singapore Teaching Practice document
The Singapore Teaching Practice document
 
How to Show Error_Warning Messages in Odoo 17
How to Show Error_Warning Messages in Odoo 17How to Show Error_Warning Messages in Odoo 17
How to Show Error_Warning Messages in Odoo 17
 
Practical Research 1 Lesson 9 Scope and delimitation.pptx
Practical Research 1 Lesson 9 Scope and delimitation.pptxPractical Research 1 Lesson 9 Scope and delimitation.pptx
Practical Research 1 Lesson 9 Scope and delimitation.pptx
 
Ultra structure and life cycle of Plasmodium.pptx
Ultra structure and life cycle of Plasmodium.pptxUltra structure and life cycle of Plasmodium.pptx
Ultra structure and life cycle of Plasmodium.pptx
 
Philosophy of Education and Educational Philosophy
Philosophy of Education  and Educational PhilosophyPhilosophy of Education  and Educational Philosophy
Philosophy of Education and Educational Philosophy
 
Practical Research 1: Lesson 8 Writing the Thesis Statement.pptx
Practical Research 1: Lesson 8 Writing the Thesis Statement.pptxPractical Research 1: Lesson 8 Writing the Thesis Statement.pptx
Practical Research 1: Lesson 8 Writing the Thesis Statement.pptx
 
Patterns of Written Texts Across Disciplines.pptx
Patterns of Written Texts Across Disciplines.pptxPatterns of Written Texts Across Disciplines.pptx
Patterns of Written Texts Across Disciplines.pptx
 
Human-AI Co-Creation of Worked Examples for Programming Classes
Human-AI Co-Creation of Worked Examples for Programming ClassesHuman-AI Co-Creation of Worked Examples for Programming Classes
Human-AI Co-Creation of Worked Examples for Programming Classes
 
Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.
 
3.21.24 The Origins of Black Power.pptx
3.21.24  The Origins of Black Power.pptx3.21.24  The Origins of Black Power.pptx
3.21.24 The Origins of Black Power.pptx
 
How to Add Existing Field in One2Many Tree View in Odoo 17
How to Add Existing Field in One2Many Tree View in Odoo 17How to Add Existing Field in One2Many Tree View in Odoo 17
How to Add Existing Field in One2Many Tree View in Odoo 17
 
Prelims of Kant get Marx 2.0: a general politics quiz
Prelims of Kant get Marx 2.0: a general politics quizPrelims of Kant get Marx 2.0: a general politics quiz
Prelims of Kant get Marx 2.0: a general politics quiz
 
The basics of sentences session 10pptx.pptx
The basics of sentences session 10pptx.pptxThe basics of sentences session 10pptx.pptx
The basics of sentences session 10pptx.pptx
 
Quality Assurance_GOOD LABORATORY PRACTICE
Quality Assurance_GOOD LABORATORY PRACTICEQuality Assurance_GOOD LABORATORY PRACTICE
Quality Assurance_GOOD LABORATORY PRACTICE
 
Finals of Kant get Marx 2.0 : a general politics quiz
Finals of Kant get Marx 2.0 : a general politics quizFinals of Kant get Marx 2.0 : a general politics quiz
Finals of Kant get Marx 2.0 : a general politics quiz
 

RHEUMATOID ARTHRITIS (VK)

  • 1. What is Arthritis?  There are 127 different kinds of arthritis!  Osteoarthritis: progressive degeneration of joint cartilage. Minor degree of inflammation.  Rheumatoid arthritis: Severe inflammation that involves many joints and moves beyond musculoskeletal system.  Gout: Very painful form of arthritis characterized by the formation of uric acid crystals and severe inflammation.
  • 2. Rheumatoid arthritisChronic progressive, autoimmune disease in which there is joint inflammation, synovial proliferation, and destruction (crippling) of articular cartilages with waxing and waning course. INFLAMMATORY MEDIATORS- Cytokines Interleukin 1 TNF-alpha
  • 3. Autoimmune IgM activates complements and release infl. Mediators Neutrophil infiltration Release of Lysosomal enzymes PGs Damage to cartilage, bone errosion vasodilatation edema & pain
  • 7. • Diagnosis – – – • Early diagnosis is the first step to easy control History Physical examination Findings 1.Morning stiffness >1hour 2.Symetrical joint swelling for 6 weeks. 3.Swelling in 3 or more joint areas lasting for 6 weeks or more. 4.Rheumatoid nodule. 5.Positve RF. 6.Radiographic erosions.
  • 8. The treatment approach: 1. Aims to reduce & possibly prevent damage to the joints & other organs. 2. Relief of pain –primary aim. 3. Rx of pathology- Arrest of disease process - Modification of disease process - Nonpharmacological therapy: o Traditional physical therapy includes-heat & cold therapy o Motion exercises, Aerobic exercise with muscle strength. Pharmacological therapy: o NSAIDs o DISEASE MODIFYING ANTIRHEUMATIC DRUGS [DMARDs] o Adjuvant: GLUCOCORTICOIDS
  • 9. NSAIDs• Used in first; they afford symptomatic relief of pain, swelling, morning stiffness, immobility. • Donot arrest disease process.      Diclofenac sodium (75-100mg BD) Ibuprofen (200-400mg TDS) Naproxen (500mg single dose) Aspirin (3-5g/day) Indomethacin Special precautions - Peptic ulcer -Bleeding disorder
  • 10. DISEASE MODIFYING ANTIRHEUMATIC DRUGS [DMARDs] • Suppress the rheumatoid process i.e. arrest the basic process of joint destruction • Bring about remission. • Also called as SAARDs »Contd.,
  • 11. DMARDs • 1.Methotrexate (Mtx.) • 2. Agents used in mild disease or in combination with MTX. • • • • 3.Traditional DMARDs -(limited used currently) • • • • Gold salts (Aurothiomalate sodium)…..X d-Penicillamine………………………..X Azathioprine 4. Biological agents • • • • Hydroxychloroquine Sulfasalazine Minocycline Cyclosporine Infliximab Leflunomide Methoterxate, Azathioprine, Cyclosporine are IMMUNOSUPPRESANT Leflunomide IMMUNO MODULATOR
  • 12. METHOTREXATE (Mtx) • An anti metabolite (inhibit dihydrofolate reductase) inhibits folic acid synthesis. • 1st line DMARD at present • RA-Primary MOA is anti-inflammatory rather than antimetabolites -Inhibit cytokine production, cell mediated immune reaction, chemotaxis. • Dose-7.5-10 mg oral weekly. • Onset of symptom relief is relatively rapid – preferred for initial treatment »Contd.,
  • 13. • PK- Oral BV of Mtx is variable, may effected by food - Excretions is dec. in renal disease pt. • S/E-GIT distress (parenteral therapy effective to reduce 30mg/wk. i.v, less expensive.) -Oral ulcer -Hair loss -Pneumonia (dec. By use of FA) -Dose dependent progressive liver damage
  • 14. Hydroxychloroquine • Antimalarial • Antirheumatic-found to induce remission in 50% patients. • MOA-inhibit inflammatory cells: monocytes interleukins, B lymphocytes. • RA- long periods • Dose-200mg bd • Combined with MTX. • S/ERetinal damage Corneal opacities Neuropathy, Myopathy Rash Graying of hairs Irritable bowel syndrome
  • 15. Sulfasalazine • Combination of sulphapyridine and 5 aminosalicylic acid • Inhibits generation of superoxides and cytokines by the inflammatory cells. • Efficacy is equal to chloroquine. • 1-3g/day (3divided dose) • Few adverse effect / good alternative for Mtx Minocycline • Group III broad spectrum antibiotic inhibit arthritic inflammation. • Used in com. With MTX.
  • 16. Gold salts (Aurothiomalate sodium) • Introduced in 1929. • Gold is most effective agent for arresting rheumatic process and preventing involvement of additional joints. • It reduce chemotaxis, phagocytosis, macrophages and lysosomal activity and inhibit cell mediated immunity • Benefit - 4-6wks • Starting dose10mg im/wk gradually inc. to 50mg/im/wk up to 1g.then maintain 50mg /im/ for few months. »Contd.,
  • 17. • PK:-Gold is heavily bound to plasma and tissue proteins, specially in kidney, stay in the body for years • Toxicity:– Vasodilatation, postural hypotension – Dermtitis, pruritic rash, – Albuminuria – Hepatitis, peripheral neuritis, pulmonary fibrosis – Eosinophilia , bone marrow suppression
  • 18. D-Penicillamine • Copper chelating agent • Gold compound like action but less efficacious. • Toxicity is similar like gold • Toxicity: Rash, Proteinurea, Kidney damage, bone marrow depression • Dose: Start with 125-250mg OD, then 250mg BD.
  • 19. Azathioprine • Purine antimetabolite • Potent suppressant of cell mediated immunity • Affect differentiation and function of T-cells and natural killer cells • Remission in RA is less but some cases not responding to gold may respond to it. • Given along with corticosteroid • Dose: 2.5-5mg/kg/day
  • 20. 4.Biological agents Infliximab• Chimeric IgG1-kappa monoclonal antibody • Anti TNF antibodies • Binds to soluble, bound both the forms of TNF and thus causes dose dependent neutralization of TNF alpha. • Useful in patients resistant to DMARDs and Methotrexate. • Given IV, half life 8-12 days. • A/E: N,V,H and coughing. other use-Crohn’s disease. »Contd.,
  • 21. Entanercept • Dimer consisting of TNF receptor joined to Fc domain of human IgG…..binds to TNFα & β. • Given by SC route thrice a wk. • Effective in juvenile RA where Infliximab is found ineffective. Levamisole • Antihelminthic in a dose of 150 mg. • MOA-unknown • A/E- Agranulocytosis
  • 22. Leflunomide: • Recently introduced immunomodulator • It inhibits proliferation of activated lymphocytes in patients with active RA. • Arthritic symptoms are suppressed and radiological progression is retarded • It is rapidly converted in the body to active metabolite, which inhibits dihydroorotate dehydrogenase and pyrimidine synthesis in actively growing cells. »Contd.,
  • 23. • It is alternative for MTX or Sulfasalazine • Dose: Loading dose of 100mg daily for 3days followed by 20mg OD (t1/2 2 wks) • S/E: Elevation of liver enzymes, renal impairment and teratogenic effect 23
  • 24. • Adverse effects:- D, H, N, rashes, loss of hair, thrombocytopenia, chest infection • C/I:children, pregnant and lactating women.
  • 25. Corticosteriods • Potent immunosuppressants and antiinflammatory drugs. • Inducted at any stage in RA. • They do not arrest the rheumatoid process nor prevent erosions. • Long term use of corticosteroid carries serious disadvantages.. Low dose 5-10mg • High dose employed over short periods in cases with severe systemic manifestations.

Notas del editor

  1. Exercise recommendations are tricky for arthritis. Research is changing quickly on this topic. Mention that fibromyalgia is also increasingly diagnosed (refer to fact sheets).
  2. (RF) is the autoantibody (antibody directed against an organism's own tissues) that is most relevant in rheumatoid arthritis.[1] It is defined as an antibody against the Fc portion of IgG. RF and IgG join to form immune complexes that contribute to the disease process Raised rheumatoid factor levels of 25-50 IU/mL, 50.1-100 IU/mL and more than 100 IU/mL were compared with normal levels (less than 25 IU/mL). 
  3. slow acting anti-rheumatic drugs (SAARDs),,,, A period during which symptoms of disease are reduced (partial remission) or disappear (complete remission). With regard to cancer, remission means there is no sign of it on scans or when the doctor examines you. Doctors use the word 'remission' instead of cure when talking about cancer because they cannot be sure that there are no cancer cells at all in the body. So the cancer could come back in the future, although there is no sign of it at the time. 
  4. Chemotaxis is the phenomenon whereby somatic cells, bacteria, and other single-cell or multicellular organisms direct their movements according to certain chemicals in their environment. This is important for bacteria to find food (for example, glucose) by swimming towards the highest concentration of food molecules, or to flee from poisons (for example, phenol). In multicellular organisms, chemotaxis is critical to early development (e.g. movement of sperm towards the egg during fertilization) and subsequent phases of development (e.g. migration of neurons orlymphocytes) as well as in normal function. In addition, it has been recognized that mechanisms that allow chemotaxis in animals can be subverted during cancer metastasis.