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ARTHRITIS CASE
STUDY
CPT3 2014
Sarah Chai 1104039
Ashley Graham
Jodian Francis
Carla Samuels
Patrice Cobourne
Stephanie Clarke Calvert
Onika Davis
OBJECTIVES
Identify the signs and symptoms of rheumatoid arthritis
Fatigue
Sixteen(16) tender
(polyarthritis).
and
swollen
joints
bilaterally
LABORATORY VALUES
Decreased hemoglobin levels 10.8 g/dl. (normal for females: 12-14 g/dl).
Increased Erythrocyte sedimentation rateESR, 55mm/hr. (normal for
females: 0 29mm/hr.)
Positive Rheumatoid Factor
A positive result for cyclic citrullinated peptide (anti-CCP) antibodies
and PIP joints bilaterally with measurable joint space narrowing from
previous X-Ray 3 months ago. Erosion are usually indicative of inflammatory
diseases and normally suggest that there is structural damage.
ADDITIONAL INFORMATION TO
ASSES PATIENT
To assess disease activity the following are
required:
C Reactive Protein
Complete Blood Count
Rheumatoid Factor - antibody present in 70 to
80% of patients with RA
Inflammatory Joint Fluid
Pain Score
Degree of joint tenderness / swollenness
SEVERITY OF RA
The information obtained in the case indicates that the patient
has moderate rheumatoid arthritis.
Characteristics of Moderate Rheumatoid Arthritis
loss of bone density, and perhaps evidence of early bony
GOALS OF PHARMACOTHERAPY
Improve functional status
Improve quality of Life
To decrease disease activity
To control joint pain
To maintain ones ability to function in daily activities and work
To delay disability
To slow the destructive joint changes
To be able to be on medication for RA as well as able to have children
To make the patient feel more energetic and decrease the feeling of being
tired.
To improve muscle strength
To increase range of motion of fingers, wrists and shoulders
To decrease inflammation of joints
Methotrexate vs Pregnancy
Methotrexate vs Fertility
Methotrexate vs Alcohol
Naproxen vs Alcohol
Indication for therapy- Anemia
Rheumatoid Arthritis vs Alcohol consumption
NONPHARMACOLOGICAL
BENEFITS
Occupational therapy - Self help devices enable patients
joint replacements
PHARMACOLOGICAL
ALTERNATIVES
Max: 3g QD
BIOLOGIC DMARDS
Adalimumab (Humira) 40 mg SQ every other
week
Etanercept (Enbrel) 50 mg SQ weekly given as
one 50 mg injection or two 25 mg injections in
one day
Infliximab (Remicade) 3mg/kg IV at 0,2 and 6
weeks, then ever 8 weeks
Certolizumab (Cimzia) 400 mg SQ (as 2 SQ
injections of 200 mg) once and then repeat at
weeks 2 and 4
BIOLOGIC DMARDS
Abatacept (Orencia) 750 mg IV over 30 min
NONSTEROIDAL
ANTIINFLAMMATORY DRUGS
Aspirin 650mg PO QID
Celecoxib 100- 200mg PO BID
Meloxicam 7.5mg PO OD
Ibuprofen 400mg PO TID
week x3/12
Prednisone 5mg PO OD x 2/52
Folic Acid 1mg PO OD x3/12
OUTCOME EVALUATION
Signs of improvement with drug therapy includes:
Reduction in joint swelling
Decreased warmth over actively involved joints.
Decreased tenderness to joint palpation
Reduction in joint pain and morning stiffness
Improvement in ability to perform daily
activities.
Longer time to onset of afternoon fatigue.
OUTCOME EVALUATION
Periodic joint radiographs may be useful in assessing
disease progression.
Increasing Hemoglobin and hematocrit to normal levels.
Reduction in ESR levels to less than 30mm/hr.
Reduction in the DAS 28 value to less than 3.2.
Laboratory is of little value to monitoring response to
therapy but is essential in determining and preventing
adverse drug effects.
Patients should be questioned about the presence of
symptoms that may be related to adverse drug effects.
PSYCHOLOGICAL CONSIDERATIONS
Based on the case presented the patient is an
Executive secretary;
married for 3 years;
wants to start a family within the next year, as
such two of the three psychsocial considerations
are evident within this patients life that is her
work and family life.
Being employed positively influences perceived
quality of life; conversely, energy consumed at
work may have negative effects on health status.
PSYCHOLOGICAL
CONSIDERATIONS
Job loss resulting from arthritis is associated
ECONOMIC CONSIDERATIONS
The economic considerations of Rheumatoid Arthritis are
PATIENT EDUCATION
INFORMATION TO ENHANCE
ADHERENCE
Patient Education Educating patients about their disease and
INFORMATION TO ENSURE
SUCCESSFUL THERAPY
Keep up with follow ups and appointments with
REFERENCES
Fransen J; van Riel PLCM. The disease activity score and the EULAR response
REFERENCES
Anonymous. Certolizumab pegol and pregnancy, . Organization of