Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints. It affects around 1-2% of the population, most often women. Treatment involves controlling inflammation to slow disease progression and manage symptoms. This is achieved through a combination of pharmacological and non-pharmacological therapies including NSAIDs, corticosteroids, DMARDs, biologics, exercise, and assistive devices. The goal of treatment is reduced joint tenderness, swelling and pain as well as improved quality of life. Careful monitoring is required due to potential adverse effects of long-term drug therapy.
RHEUMATOID ARTHRITIS BY DR BASHIR AHMED DAR ASSOCIATE PROFESSOR MEDICINE SOPO...Prof Dr Bashir Ahmed Dar
Dr Bashir ahmed dar associate professor medicine chinkipora sopore kashmir presently working in medical college malaysia describes rheumatoid arthritis which is a autoimmune disorder in which Immune system identifies the synovial membrane as "foreign" and begins attacking it.
12.01.08(a): Rheumatoid Arthritis/Pathogenesis and Clinical Presentation of J...Open.Michigan
Slideshow is from the University of Michigan Medical School's M2 Musculoskeletal sequence
View additional course materials on Open.Michigan:
openmi.ch/med-M2Muscu
Kenneth C. Kalunian, MD, Maureen A. McMahon, MD, and Joan T. Merrill, MD, prepared useful practice aids pertaining to systemic lupus erythematosus for this CME activity titled "Candid Conversations in Lupus: Navigating Advances in Diagnosis and Treatment to Provide Optimal Care for Each Patient." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at https://bit.ly/2zki5EQ. CME credit will be available until September 14, 2021.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
4. The prevalence estimated to be between 1% and 2% ,
with women affected 3 times more often than men
Rheumatoid arthritis can occur at any age and often
occurs in younger people.
Rheumatoid arthritis is an autoimmune disease with a
strong genetic predisposition.
6. Chronic inflammation of the synovial tissue lining the
joint capsule results in the proliferation of this tissue.
The inflamed proliferating synovium characteristic of
rheumatoid arthritis Is called pannus.
This panes invades the cartilage and eventually the
bone surface, producing erosions of bone and cartilage and
leading to destruction of the joint.
The factors that initiate the inflammatory process are unknown
7.
8.
9.
10. The immune system is a
complex network of checks
and balances
designed to discriminate
self from non-self (foreign)
tissues.
It helps rid the body of
infectious agents, tumor
cells, and products
associated with the
breakdown of cells.
In rheumatoid arthritis, this
system no longer can
differentiate self from non-
self tissues and attacks the
synovial tissue and other
connective tissues
11.
12. The immune system has both
humeral and cell-mediated
functions.
The humeral component is
necessary for the
formation of antibodies. These
antibodies are produced by
plasma
cells, which are derived from B
lymphocytes.
Most patientswith rheumatoid
arthritis form antibodies called
rheumatoid factors
13. Symptoms
■Joint pain and stiffness of more than 6 weeks’ duration
May also experience fatigue, weakness, low-grade fever,
Loss of appetite. Muscle pain and afternoon fatigue may also be
present.
Joint deformity is generally seen late in the disease.
Signs
■Tenderness with warmth and swelling over affected joints
usually involving hands and feet. Distribution of joint involvement
is frequently symmetrical. Rheumatoid nodules may also be
present
14. Laboratory Tests
■Rheumatoid factor (RF) detectable in 60% to 70%.
■Ant cyclic citrullinated peptide (anti-CCP) antibodieshave
similar sensitivity to RF (50% to 85%) but are morespecific
(90% to 95%) and are present earlier in the disease.
■Elevated erythrocyte sedimentation rate and C-reactive
protein are markers for inflammation.
■Normocytic normochromic anemia is common as is
thrombocytosis.
15. Other Diagnostic Tests
■Joint fluid aspiration may show
increased white blood cell
counts without infection, crystals.
■Joint radiographs may show
periarticular osteoporosis, joint
space narrowing, or erosions
17. LABORATORY FINDINGS
Normocytic normochromic anemia
Thrombocytosis
Leucopenia
ESR is elevated
C-reactive protein elevated
RF present in 60-70 % of patient
Anti- CCP antibody in 50-85%
Antinuclear antibodies in 25%
18. Diseases Associated with a
Positive
Rheumatoid Factor
Rheumatic diseases
Rheumatoid arthritis
Sjögren’s syndrome (with or without
arthritis)
Systemic lupus erythematosus
Progressive systemic sclerosis
Polymyositis/dermatomyositis
Infectious diseases
Bacterial endocarditis
Tuberculosis
Syphilis
Infectious mononucleosis
Infectious hepatitis
Leprosy
Other causes
Aging
Interstitial pulmonary fibrosis
Cirrhosis of the liver
Chronic active hepatitis
Sarcoidosis
20. DESIRED OUTCOME
Control of inflammation is the key to slowing
or preventing disease progression as well
as managing symptoms
21. a. Reduction in the number of affected joints
and in joint tenderness and swelling
b. Improvement in pain
c. Decreased amount of morning stiffness
d. reduction in serological markers such as RF
e. Improvement in quality-of-life scales
22. NONPHARMACOLOGIC THERAPY
a. Rest during periods of disease exacerbation
b. Occupational and physical therapy to support
mobility and maintain function
c. Maintenance of normal weight to reduce
biomechanical stress on joints
d. Surgery (Tenosynovectomy, tendon repair,
And joint replacements).
e. Smoking Cessation
23. PHARMACOLOGIC THERAPY
Drug therapy should be only part of a
comprehensive program for patient management
which would also Include physical therapy,
exercise, and rest.
surgery may beAssistive devices and orthopedic
necessary in some patients
24. There are four types of medications used to treat RA:
Non-steroidal anti-inflammatory drugs (NSAIDs)
Corticosteroids
Disease-modifying anti-rheumatic drugs(DMARDS).
Biologic Response Modifiers (“Bioligics”)
25. Disease-modifying antirheumatic drugs (DMARDs) or
biologic agents should be started within 3 months of the
diagnosis of rheumatoid arthritis.
Methotrexate ,hydroxycloroquine ,leflunomide ,and
sulphasalsine are commonly used as first line gents
Nonsteroidal antiinflammatory drugs and/or corticosteroids
should be considered adjunctive therapy early in the course
of treatment and as needed if symptoms are not adequately
controlled with DMARDs.
26. When DMARDs used singly are ineffective or not
adequately effective, combination therapy with
two or more DMARDs or a
DMARD plus biologic agents may be used to
induce a response.
Patients require careful monitoring for toxicity and
therapeutic benefit for the duration of treatment
27. NSAIDs and/or corticosteroids may be used for
symptomatic relief if needed.
They provide relatively rapid improvement in
symptoms compared with DMARDs, which
may take weeks to months before benefit is
seen; however, NSAIDs have no impact on
disease progression and the long-term
complication risk of corticosteroids make
them less desirable
29. Examples General Use Side Effects Monitoring
Considerations
Aspirin, ibuprofen,
naproxen, COX-2
inhibitors, propionic acid,
phenylacetic acid
• anti-
inflammatory:
Used in the
management
inflammatory
conditions
•Antipyretic: used
to control fever
•Analgesic:
Control mild to
moderate pain
•Nausea
•Vomiting
•Diarrhea
•Constipation
•Dizziness
•Drowsiness
•Edema
•Kidney failure
•Liver failure
•Prolonged bleeding
•Ulcers
•Use cautiously in
patients with hx of
bleeding disorders
•Encourage pt to avoid
concurrent use of
alcohol
•NSAIDs may decrease
response to diuretics
or antihypertensive
therapy
(The Arthritis Society, 2011; Day et al., 2010)
31. Used in bridging therapy
Corticosteroids also may be delivered by
injection
Patients on long-term therapy should be given
calcium and vitamin D or Alendronate to minimize
bone loss.
32. Examples General Use Side Effects monitoring
Considerations
Cortisone, hydrocortisone,
prednisone,
betamethasone,
dexa-methasone
• Used in the
management
inflammatory
conditions
•When NSAIDS
may be
contraindicated
•Promptly
improve
symptoms of RA
•Increased appetite
•Weight gain
•Water/salt retention
•Increased blood
pressure
•Thinning of skin
•Depression
•Mood swings
•Muscle weakness
•Osteoporosis
•Delayed wound
healing
•Onset/worsening of
diabetes
•Take medications as
directed (adrenal
suppression)
•Used with caution in
diabetic patients
•Encourage diet high
in protein, calcium,
potassium and low in
sodium and
carbohydrates
•Discuss body image
•Discuss risk for
infection
(The Arthritis Society, 2011; Day et al., 2010)
34. Examples General Use Side Effects Monitoring
Considerations
Methotrexate
Hydroxychloroquine
lefulinamide
(the gold standard)
, gold salts,
cyclosporine,
cyclophosphamide
sulfasalazine,
azathioprine
•immunosuppressive
activity
•Reduce inflammation of
rheumatoid arthritis
•Slows down joint
destruction
•Preserves joint function
•Dizziness, drowsiness,
headache
•Pulmonary fibrosis
•Pneumonitis
•Anorexia
•Nausea
•Hepatotoxicity
•Stomatitis
•Infertility
•Alopecia
•Skin ulceration
•Aplastic anemia
•Thrombocytopenia
•Leukopenia
•Nephropathy
•fever
•photosensitivity
•May take several
weeks to months
before they
become effective
•Discuss
teratogenicity,
should be taken off
drug several
months prior to
conception
•Discuss body
image
(The Arthritis Society, 2011; Day et al., 2010)
35. Methtrexate
DMARD of choice
CI in chronic liver disease,
immunodeficiency,thrpmpocytopenia,leucopenia,
preexisting blood disorders , cr <40
Inhibit cytokine production
Git side effect , liver toxicity
Folic acid antagonist
Dose and Administration
Dose ranges from 7.5 to 25 mg
ONLY GIVEN ONCE A WEEK
2.5 mg Tablets or Subcutaneous Injection 25
mg/mL
36.
37. Tetrahydrofolate is an important cofactor in the production of purines
transferring a carbon atom
42. Examples General Use Side Effects Nursing
Considerations
Etanercept,
anakinra,
abatacipt,
adalimumab,
Infliximab (Remicade)
• Used in the
management
inflammatory
conditions
•When NSAIDS
may be
contraindicated
•Promptly
improve
symptoms of RA
•Increased appetite
•Weight gain
•Water/salt retention
•Increased blood
pressure
•Thinning of skin
•Depression
•Mood swings
•Muscle weakness
•Osteoporosis
•Delayed wound
healing
•Onset/worsening of
diabetes
•Take medications as
directed (adrenal
suppression)
•Encourage diet high
in protein, calcium,
potassium and low in
sodium and
carbohydrates
•Discuss body image
•Discuss risk for
infection
48. EVALUATION OF THERAPEUTIC OUTCOMES
The evaluation of therapeutic outcomes is based primarily on
improvements of clinical signs and symptoms of rheumatoid
arthritis.
Clinical signs of improvement include a reduction in joint swelling,
decreased warmth over actively involvedjoints, and decreased
tenderness to joint palpation. Improvement in rheumatoid arthritis
symptoms includes reduction in perceived joint pain and morning
stiffness, longer time to onset of afternoon fatigue, and
improvement in ability to perform activities of daily living.
Improvement of activities of daily living may be assessed
objectively using a Health Assessment Questionnaire score.
.
49. Joint radiographs may be of some benefit in assessing the
progression of the disease and should show little or no
evidence of disease progression if treatment is effective.
Laboratory monitoring is of little value in monitoring individual
patient response to therapy. Routine monitoring of patients is
essential to the safe use of these drugs.
In addition, patients should be questioned about
symptoms of the adverse effects outlined previously
