1. Rheumatoid Arthritis:
    • An autoimmune, inflammatory disorder
    • Joints are destroyed by autoimmune process
    • Immune system attacks synovial tissue
  2. Goals of Treatment for Rheumatoid Arthritis:
    • 1. Relieve symptoms
    • 2. Maintain joint function
    • 3. Minimize systemic involvement
    • 4. Delay disease progression
  3. Treatment Types for Rheumatoid Arthritis:
    • Non-drug Measures:
    • -Physical therapy, exercise, surgery
    • Drug Therapy:
    • -Nonsteroidal anti-inflammatory drugs
    • -Glucocorticoids
    • -Disease-modifying antirheumatic drugs
  4. 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
  5. 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
  6. DMARDs are subdivided:
    • Nonbiologic- Small molecules/traditional chemical techniques
    • Biologic- Large molecules/ recombinant DNA technology
    • -very expensive
  7. What do DMARDs do for Rheumatoid Arthritis:
    • Decrease inflammation
    • Immunosuppressant
    • Risk of serious infections!
  8. Glucocorticoids for Rheumatoid Arthritis:
    • Powerful anti-inflammatory
    • May slow progression of RA
    • Long term use can cause toxicity
    • Osteoporosis
    • Gastric Ulceration
    • Adrenal suppression
  9. 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
  10. Gout:
    • Recurrent inflammatory disorder (severe pain)
    • Hyperuricemia
    • Sodium urate crystalizes in synovial space
    • -this sets off inflammatory response
  11. Treatment for Gout:
    • NSAIDs most common
    • -Glucocorticoids are acceptable

    • Drugs for Hyperuricemia:
    • -Drugs that decrease production
    • -Drugs that increase secretion
  12. Hyperuricemia=
    Uric Acid- above 7 in men, above 6 in women
  13. Drugs For Hyperuricemia:
    • Used on patients with frequent attacks (3 or more/yr)
    • Allopurinol and Febuxostat
    • Probenecid and Sulfinpyrazone
  14. Allopurinol and Febuxostat:
    Decrease production of uric acid
  15. Probenecid and Sulfinpyrazone:
    Increase excretion of uric acid
  16. 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
  17. What regulates Calcium
    • Parathyroid hormone
    • Vitamin D
    • Calcitonin
  18. Bisphosphonates:
    • Fosamax
    • Actonel
    • Boniva

    • 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!!)
  19. 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)
  20. Teriparatide- Forteo
    • A form of parathyroid hormone
    • Only drug for osteoporosis that INCREASES BONE FORMATION
    • All others decrease bone resorption
Card Set
Bones and Joints