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Rheumatoid Arthritis
Question | Answer |
---|---|
Rheumatoid Arthritis | RA is a classic autoimmune disease with abnormalities of cellular and humoral components of immunity. |
Pannus | Major cell types: 1. Macrophages 2. T Lymphocytes Minor cell types: 1. Dendritics cells 2. Endothelium 3. Plasma cells 4. Fibroblast |
Cellular Immunity | relies on thymus to delete self-reactive lymphocytes, forming T-cells. |
T-cell | - Direct destruction of infected cells. - orchestration of further immune response. |
Humoral Immunity | - relies on cellular maturation in the bone marrow resulting in B cell. |
B-cell | 1. production of antibodies 2. contribute to inflammation |
COX 1 | 1. constitutive form of COX. 2. poor inducibility. 3. Smaller active site. 4. PG tat regulate normal kidney & stomach function. 5. substract only C20 carboxylic.acd. 6. main source of PGs in CHRONIC inflammation 7. Acetylation of SEr 530 by aspirin. |
COX 2 | 1. Inducible form of COX. 2. Induced during inflammation. 3. produce PGs inolved in inflammation. 4. larger active site. 5. Substrates C18 & C20 C.A. 6. Main source of PG in ACUTE inflam. 7. Acetylation of ser516. |
NSAIDs s/e | 1. heartburn 2. dyspepsia 3. abdominal pain - inhibition of prostaglandin which act as the protective of the GI tract. 4. serious: Bleeding/ ulceration * PPI should be prescribed with long term NSAIDs. |
Sulfasalazine | 500mg once daily nausea/rashes/ bone marrow suppression |
Methotrexate | 5-25mg once weekly rashes/nausea/ stomatitis/ hepatitis |
Sodium aurothiomalate | 10mg test then 50mg weekly rashes/ stomatitis/ marrow suppression |
penicillame | 250-750mg once daily on empty stomach rashes/ nausea/ taste disturbance |
cyclosporin | 2.5mg/kg/day renal impairment |
Leflunomide | 10-20mg daily for maintanence, 100mg for loading dose- 3 days GI disturbance/hypertension/alopecia(loss of hair) |
Azathioprine | 1.5-2.5mg/kg/day nausea/hepatitis/ marrow suppression |