Arthritis Rheumatology
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Rheumatoid Artheritis – (Rheumatology/Orthopaedics) questions?
If anyone knows the below answers, it would be much appreciated!
(ps- i study RA a bit, so dont really need overview/web site referral, just these spec questions thankyou)
1) What are the biological agents used to treat RA(Rheumatoid Arthritis)?
2) RA causes anaemia of chronic disease – what does this blood picture look like?
3) Late surgery for RA may mean joint replacement/etc – what is the early options for surgery in RA?
4) Whats the role in splinting for RA?
1. RA is usually treated with combinations of DMARDs (disease modifying agents) like methotrexate, hydroxychoroquine, sulfasalazine, and leflunomide. Early disease or acute episodes of inflammation are also treated with NSAIDs such as aspirin or ibuprofen, COX-2 inhibitors like celecoxib(celebrex), and/or steroids like prednisone.
2. In anemia of chronic disease, you will see both a decrease in the marrow erythroid mass and a microcytic anemia. In microcytic anemia the average size of the red blood cells is smaller than normal & the mean corpuscular volume is 80 or less.
3. Along with the medications listed in #1, the early treatment goals are to intervene before joint damage occurs so the emphasis is on exercise and mobility and reduction of joint stress. Options include hydrotherapy/water excercise and isometric exercise. Patients are instructed to stay active but also to avoid heavy work and vigorous excercises during exacerbations and active synovitis. Also, patients are instructed to maintain a diet rich in omega 3 fatty acids (25g/day) which has been shown to allow some patients to reduce their NSAID doses.
4. Splinting is used to maintain upper limb joint function and mobility but it’s use is declining due to the fact that the synovitis responsible for symptoms of pain & stiffness is better controlled with medication.
Carolyn Bell, MD, UW Health Rheumatology and Arthritis