Question

Ms. RR is 32 years of age and has been visiting your pharmacy for 2 years. She is approximately 150 cm in height and weighs approximately 55 kg. Her fingers appear swollen at the knuckles and her hands appear slightly deformed. In the time you have known her, she had complained of stiffness in her fingers and wrists, especially in the mornings, and now her mobility appears to have diminished. She has been taking ibuprofen for that time. In the last year, Ms. RR had been on methotrexate and sulfasalazine. Recent laboratory findings indicate an erythrocyte sedimentation rate (ESR) of 85 mm/hour, the presence of rheumatoid factor (RF) in serum and normochromic, normocytic anemia. She is now presenting with a prescription for etanercept. The drug is to be administered as a 25-mg dose by subcutaneous injection, twice weekly.

1. What is rheumatoid arthritis?

2. What are the predisposing factors associated with rheumatoid arthritis?

3. What are the laboratory findings associated with rheumatoid arthritis?

4. How is rheumatoid arthritis treated?

5. What are TNF-á inhibitors?

6. When would etanercept be prescribed and is it appropriate for Ms. RR?

7. What type of preparation is etanercept?

8. How should the response to etanercept be monitored?

9. What advice should you give Ms. RR?

Answer 1

1. Rheumatoid arthritis

Rheumatoid arthritis is a chronic autoimmune inflammatory disorder characterized by Inflammation of one or more joints, causing pain and stiffness that can worsen with age.

2. Predisposing factors

• Genetic factors

a close family member has RA, a person may have a higher risk of developing it themselves

• Hormone

women are two or three times more likely to develop RA than men due to high level of estrogen hormone

• Menopause

During and after menopause, females with RA often find it harder to function physically.

• Obesity

obesity with several health issues, such as metabolic syndrome, that can exacerbate RA symptoms. For example, inflammation is a common feature of both obesity

• Smoking cigarette smoking, can increase a person’s risk of developing RA later in life.
• Previous infections - the infection triggers the production of new antigens, causing the immune system to become overactive
• Diet : unhealthy diet

3.People with rheumatoid arthritis often have an elevated erythrocyte sedimentation rate (ESR, or sed rate) or C-reactive protein (CRP) Other common blood tests look for rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies.

Tests

Rheumatoid factor.

Anti-Cyclic Citrullinated Peptide.

C-Reactive Protein (CRP).

Erythrocyte Sedimentation Rate (ESR).

Antinuclear Antibody (ANA).

4.Treatment

Treatment consists of self care and therapy

• Medication
• physiotherapy or sometimes surgery helps reduce symptoms and improve quality of life.

Therapies

Hydrotherapy, Stretching, Massage and Acupuncture

Self-care

Physical exercise, Weight loss, Yoga, Heating pad, Ice packs and Cold compress

Surgery

Hip replacement, Knee replacement and Joint replacement

Medications

Nonsteroidal anti-inflammatory drug, Steroid, Analgesic, Narcotic and Immunosuppressive drug