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Monday, December 3, 2012
  Clinical Accuracy Spoken Here  

RA: Inflammatory Physiology

TNF-alpha, a product of monocytes and macrophages, participates in inflammation in three ways:

  1. Stimulation of IL-1, IL-6, interleukin-8 (IL-8), and granulocyte-monocyte colony-stimulating factor (GMCSF) release
  2. Expression of adhesion molecules by fibroblasts required for migration of leukocytes into inflammatory sites
  3. Stimulation of the release of corticotrophin from the pituitary which provides for the release of adrenal cortisol that dampens inflammatory reactions

Interleukin-4 and interleukin-10 are anti-inflammatory cytokines present in the synovial fluid of patients with RA, but in insufficient quantities to counter the ongoing inflammatory response.

[Reference: RA, Module A, Prevalence and Pathophysiology ]
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  Excellence in Case Mgmt  

RA: Informed Independence is Key

The more informed independence the RA patient achieves in terms of care, the more the patient retains a sense of control and dignity.

The ultimate goal of the CM is to assist patients in reaching the highest level of self-management of which they are capable.

The RA patient population may be one of the more challenging patient populations to merit initial screening when prompts are made solely on diagnostic coding.

[Reference: RA, Module D, CM Role]
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  Improving Patient Care...  

RA: Is there a Role
for CAM Therapies?

Defining complementary and alternative medicines (CAM) is difficult, because the field is very broad and constantly changing. CAMs are a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of medicine.

Integrative or integrated medicine refers to practices that combine both conventional and CAM treatments for which there is evidence of safety and effectiveness.

Patients should be advised to exercise caution when choosing a particular supplement or intervention, due to the lack of oversight.

[Reference: RA, Module C, Treatments and Interventions]
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