Rheumatoid Arthiritis

Slides:



Advertisements
Similar presentations
RHEUMATOID ARTHRITIS RA Inson lou. Epidemiology Symptoms signs Labs Diagnosis Treatment.
Advertisements

doc.MUDr. Želmíra Macejová, PhD III. Internal clinic LF UPJŠ
NSAIDs 1 st line of therapy in the medical management of RA.
Rheumatoid Arthritis Systemic chronic inflammatory disease
Hatem H Eleishi, MD Professor of Rheumatology, Cairo University Consultant Rheumatologist, Dr. Soliman Fakeeh Hospital Rheumatoid Arthritis Wednesday,
Efficacy of Methotrexate and/or Etanercept for treatment of RA Rheumatoid Arthritis:
Table 1. Comparison between the provisional diagnosis based on the proforma versus final diagnosis Early arthritis Rheumatoid arthritis 3 6 Psoriatic.
IMPROVING EARLY DIAGNOSIS AND TREATMENT OF RHEUMATOID ARTHRITIS Michael Lockwood, MD, FACP, FACR Rheumatology Indiana University Health Arnett.
CLINICAL CASES. Case 1: Mr. OA Mr. OA: Case Presentation 62-year-old lawyer Mild left knee pain for 3 month, but became worse 1 week ago No swelling.
What is the definition of remission in RA? American Rheumatism Association (ARA)¹ Five or more of the following criteria must be fulfilled for at least.
Tena Trbojević Mentor: A. Žmegač Horvat
Measuring Signs and Symptoms in Rheumatoid Arthritis David R. Karp, MD, PhD Chief, Rheumatic Diseases UT Southwestern Medical Center David R. Karp, MD,
All About Rheumatoid Arthritis
Hot Topics in Rheumatology Prof. MG Molloy. Overview Rheumatoid Arthritis Psoriatic Arthritis Vasculitides: SLE Osteoarthritis Osteoporosis.
New Pharmacologic Treatment Options for Managing Rheumatoid Arthritis Devra Dang, Pharm.D. Department of Pharmacy National Institutes of Health.
Treatment of Rheumatoid Arthritis Then and Now
Management of Rheumatoid Arthritis Morning stiffness Morning stiffness in and around the joints, lasting at least 1 hour before maximal improvement.
Rheumatoid Arthritis Anila Malik GPVTS. Aims To cover the following: What is RA? Diagnostic criteria and clinical features Rheumatoid Factor Investigations.
Rheumatoid Arthritis(RA)
RHEUMATOID ARTHRITIS By: Julie Le and Mary Le 5/2/12 4 th pd.
RHEUMATOID ARTHRITIS AND REHABILITATION Prof. Dr. Ülkü Akarırmak.
DR.A.Tahamoli Rudsari.  Rheumatoid arthritis (RA) is a chronic multisystem disease of unknown cause.  Although there are a variety of systemic manifestations,
Adult Medical-Surgical Nursing Musculo-skeletal Module: Rheumatoid Arthritis.
Rheumatology teaching session GP ST2 year 8/9/10.
LSU Clinical Pharmacology
Rheumatoid Arthritis.
Rheumatoid Arthritis Dr Chandini Rao Consultant Rheumatologist.
( Slow Acting Anti-inflammatory Drugs ). OBJECTIVES At the end of the lecture the students should Define DMARDs Describe the classification of this group.
Infectious arthritis Bacterial Viral Other Postinfectious (reactive) arthritis Rheumatic fever Reactive arthritis Enteric infection Other seronegative.
BY PROF. AZZA EL-MEDANY DR. OSAMA YOUSIF General Features & Conditions to use antirheumatic Low doses are commonly used early in the course of the disease.
Disease modified Anti-rheumatic drugs ( DMARD)
Rheumatoid Arthritis Christine Aranyi and Rebecca Boon State university of new york institute of technology Pathophysiolog y Rheumatoid Arthritis (RA)
EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs : 2013 update Smolen.
Rheumatoid arthritis (RA).  Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally.
Tumor necrosis factor antagonist use and associated risk reduction of cardiovascular events among patients with rheumatoid arthritis The Annals of the.
Identifying Early Inflammatory Arthritis
Rheumatoid Arthritis: Treatment options in 2017
Rheumatoid Arthritis: Management and New Therapies
Tests for Rheumatoid Arthritis
Approach to diagnosis of Rheumatoid arthritis
A NEW LOOK AT RA Interactive Hot Topics Series
Rheumatoid arthritis The Lancet
Treatment Goal of treatment reduce inflammation and pain
My Treatment Approach to Rheumatoid Arthritis
3e Initiative 2009 How to investigate and follow-up Undifferentiated Peripheral Inflammatory Arthritis? Case 3 1.
Rheumatoid Arthritis Objectives:
55 Rheumatoid arthritis.
Prediction of Response to Targeted Treatment in Rheumatoid Arthritis
Drug Therapy of Rheumatoid Arthritis
Rheumatoid ARHTRITIS Therapeutics 4th stage.
Maggie Davis Hovda, MD 3/22/2010
Rheumatology for the GP
Clinical Developments in Inflammatory Arthritis 2017
Algorithm based on the 2016 European League Against Rheumatism (EULAR) recommendations on rheumatoid arthritis (RA) management. Algorithm based on the.
Introduction/Background
Lecture 7 Rheumatologic Disorders Rheumatoid Arthritis
My Treatment Approach to Rheumatoid Arthritis
(A) EULAR response based on DAS28 (ESR, otherwise CRP) and (B) Boolean remission, at 6 months in patients treated with abatacept as a first-line biologic.
What’s new in my specialty- Rheumatoid Arthritis
What's New in Therapeutic Options for Moderate to Severe RA?
Association of disease parameters at the time of methotrexate reinitiation during the OLE based on propensity score matching. Association of disease parameters.
Improvement in PROs, TJC, SJC and PGA at month 6 in patients achieving (A) ACR50, (B) CDAI LDA and (C) HAQ-DI
Nat. Rev. Rheumatol. doi: /nrrheum
Prescription rates of (A) NSAIDs, glucocorticoids and analgaesics, (B) TNF inhibitors and synthetic DMARDs and (C) combination therapy of NSAIDs with TNF.
Improvement in PROs, TJC, SJC and PGA at month 6 in patients achieving (A) ACR70, (B) CDAI REM and (C) SDAI REM. For tofacitinib 5 and 10 mg BID treatment.
Cox proportional-hazards model of time to first RA flare after treatment withdrawal for patients who entered the re-treatment period (n=146). Cox proportional-hazards.
Percentage of patients achieving 20% improvement in the American College of Rheumatology criteria at week 12 by patient demographic and disease characteristics.
Multivariable model of adjusted
Algorithm based on the 2016 European League Against Rheumatism (EULAR) recommendations on rheumatoid arthritis (RA) management. Algorithm based on the.
Suggested therapeutic management according to subtypes and severity of rheumatic immune-related adverse events (irAE). *Add-on therapy with DMARDs (disease-modifying.
Presentation transcript:

Rheumatoid Arthiritis Burhan Khan

Background is a chronic autoimmune disease characterized by inflammation of the synovium polyarthritis affects particularly in the hands and feet, and is frequently symmetrical. inflammation results in the release of cytokines (ie, interleukins [IL-1 and IL-6] and tumor necrosis factor [TNF])  activates macrophage-like synoviocytes  further release of cytokines  chronic inflammatory state IL-6 affects the neuroendocrine system and neuropsychological behavior. Goal of targeted medications for the RA is to interfere with the inflammatory signaling by targeting the Cytokine its receptor or the downstream signaling pathway (eg, Janus kinases [JAK])

Clinical Presentation History joint pain & swelling & morning stiffness lasts >30 minutes, stiffness after prolonged sitting symptoms that have persisted for longer than 6 weeks Physical examination distribution of swollen or tender joints and limited joint motion extra-articular disease manifestations (ie, rheumatoid nodules) Symmetrical joint involvement metacarpophalangeal (MCP) & proximal interphalangeal (PIP) joints of the fingers, the interphalangeal joints of the thumbs, the wrists, the elbows, the shoulders, the ankles, the knees, and the metatarsophalangeal (MTP) joints of the toes. Early signs of RA can often be found in the hands where joint tenderness and reduced grip strength are key indicators

Diagnosis ESR; CRP; CBC with differential, liver and kidney function tests, serum uric acid Urinalysis rheumatoid factor (RF) & anti-cyclic citrullinated peptide antibody (ACPA); ANA; anti-double stranded DNA Infectious disease screening eg tuberculosis, HBV, HCV N.B. both RF and ACPA may be negative in 20% to 50% of patients with RA OR they may precede the clinical manifestation of RA by many years

Radiographic imaging Imaging of hands, wrists, and feet is essential to establish a baseline for monitoring disease progression, exclude other diagnoses, and detect characteristic joint erosion. MRI and ultrasound are not as commonly used to detect joint erosion in RA patients, but due to their increased sensitivity (compared to radiography); they may be useful in patients with negative radiographs or obesity.

ACR & EUALR diagnostic criteria European League Against Rheumatism (EULAR)

Nomenclature of RA Pharmacology disease-modifying antirheumatic drugs (DMARDs) conventional synthetic (cDMARDs or csDMARDs) MTX, Leflunomide, Hydroxychloroquine, sulfasalazine, azathioprine, cyclosporine, D-penicillamine, minocycline targeted synthetic (tDMARDs or tsDMARDs), biological originator (bDMARDs or boDMARDs) biosimilar DMARDs (bsDMARDs)

Treat-to-target (T2T) approach DMARD monotherapy (preferably MTX) regardless of disease activity combination DMARDs DMARDs + Biologics: DMARD + tumor necrosis factor inhibitor (TNFi) or non-TNF biologic or tofacitinib

Escalating T2T After TNFi  another TNFi or a non-TNF biologic with or without MTX Disease activity after TNFi therapy should be treated with a non-TNF biologic or tofacitinib with or without MTX Disease activity on a non-TNF biologic should receive a second non-TNF biologic or tofacitinib with or without MTX

Non-pharmacological measures physical occupational psychological approaches Pharmacological treatment options: synthetic DMARDs (hydroxychloroquine, leflunomide, sulfasalazine, and methotrexate) NSAIDS Glucocorticoids TNF1: Adalimumab, Eternercept, Golimumab, Infliximab, Certolizumab Anti-IL1: Anakinra Anti IL6: Toclizumab Co-stimulatory modulator: Abatacept Jak inhibitor: Tofacitinib B-cell depletion: Rituximab, Belimumab

Disease Assessment patient-reported outcome measures (PROMs) RAPID3 Pt-DAS28 (physician component removed from DAS28) evaluation by a physician CDAI (clinical disease activity index) SDAI (simplified disease activity index) DAS28 (disease activity score 28-joint count)

CDAI (clinical disease activity index) outcome measure that is the arithmetic sum of 28 joints the swollen joint count (SJC) tender joint count (TJC) patient's global assessment (PGA) evaluator's global assessment (EGA) Score: 0 to 76 No labs needed

SDAI (simplified disease activity index) the arithmetic sum of SJC TJC PGA EGA & C-reactive protein (CRP) Score: 0 to 100

DAS28 (disease activity score 28-joint count) a weighed assessment that includes SJC TJC PGA & CRP or ESR