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So, what's the difference 20 00:01:03,900 --> 00:01:06,900 between rheumatoid arthritis and osteoarthritis? 21 00:01:07,200 --> 00:01:09,400 Think about this, the presentation? 22 00:01:09,600 --> 00:01:12,700 Yeah, there is some similarities, the joint pain, of 23 00:01:12,700 --> 00:01:16,900 course, the female predominance age, things of that nature. 24 00:01:16,900 --> 00:01:18,900 So there's a lot of overlap that can happen. 25 00:01:18,900 --> 00:01:22,600 So great way for the board to ask you questions. 26 00:01:23,100 --> 00:01:28,500 However, One happens as wear and tear. 27 00:01:29,400 --> 00:01:33,200 While the other one is an autoimmune disease. 28 00:01:34,100 --> 00:01:39,300 Let's learn about the disease process first, so it's 29 00:01:39,300 --> 00:01:42,400 autoimmune. Meaning what our own immune 30 00:01:42,400 --> 00:01:48,000 system is causing this damage. We've got elevated inflammatory 31 00:01:48,000 --> 00:01:52,400 markers. What are some risk factors that 32 00:01:52,400 --> 00:01:56,400 are going to lead. To rheumatoid arthritis is what 33 00:01:56,400 --> 00:01:59,300 do I say? Risk factors and signs and 34 00:01:59,300 --> 00:02:03,200 symptoms are your select all that apply questions. 35 00:02:03,200 --> 00:02:04,900 Okay? Those are going to be a good 36 00:02:04,900 --> 00:02:07,800 makeup of reselect other place. So what are some risk factors, 37 00:02:08,300 --> 00:02:11,200 gender, family, history, or genetics? 38 00:02:13,600 --> 00:02:17,600 Smoking positive rheumatoid Factor. 39 00:02:19,500 --> 00:02:23,400 Anti cyclic to try, new lated, antibody ABS antibody. 40 00:02:24,100 --> 00:02:26,600 And this is going to be your most specific test that you can 41 00:02:26,600 --> 00:02:28,000 do. So this is the one that we're 42 00:02:28,000 --> 00:02:33,200 going to want to do and then obviously an elevated ESR, you 43 00:02:33,200 --> 00:02:35,300 see these different things. So what we can test for, as we 44 00:02:35,308 --> 00:02:39,200 test for a positive rheumatoid Factor, Great that will, that 45 00:02:39,200 --> 00:02:42,200 will help us diagnose it, but right off the bat, we don't 46 00:02:42,200 --> 00:02:45,700 necessarily want to go right into rheumatoid factor or the 47 00:02:45,700 --> 00:02:48,000 anti cyclic Citron elated antibody. 48 00:02:48,700 --> 00:02:51,600 When a person presents, they're going to present with these 49 00:02:51,600 --> 00:02:54,400 signs and symptoms of joint pain, maybe fatigue, maybe 50 00:02:54,400 --> 00:02:55,900 fever. And I'll go through those signs 51 00:02:55,900 --> 00:02:59,700 and symptoms, but we want to do an easier test a cheaper test. 52 00:02:59,800 --> 00:03:03,700 So what we want to do is we want to do an ESR, what is that? 53 00:03:03,700 --> 00:03:09,600 That's an erythrocyte sedimentation rate with the 54 00:03:09,600 --> 00:03:12,800 erythrocyte sedimentation rate, what is saying is you're saying 55 00:03:12,800 --> 00:03:14,600 erythrocytes so that's your red blood cell. 56 00:03:14,600 --> 00:03:19,000 Sedimentation is how fast it falls to the bottom of Of your 57 00:03:19,000 --> 00:03:20,500 tube. And the rate is actually how 58 00:03:20,500 --> 00:03:23,800 fast it falls, right? So why do we do this test? 59 00:03:23,800 --> 00:03:31,000 We do this testing inflammatory processes so it's not specific. 60 00:03:31,800 --> 00:03:37,100 It's not specific to rheumatoid arthritis but in any 61 00:03:37,100 --> 00:03:42,000 inflammatory process we can do this test because it is cheap. 62 00:03:42,100 --> 00:03:46,400 It's fast because what happens is when we have an inflammatory 63 00:03:46,400 --> 00:03:53,300 process in our body, Release. Fibrinogen, which is 64 00:03:53,300 --> 00:03:56,900 inflammatory marker and that fibrinogen. 65 00:03:57,900 --> 00:04:01,400 It binds to the art, be season to your red blood cells. 66 00:04:01,800 --> 00:04:05,200 So now that red blood cell that was floating around has its 67 00:04:05,200 --> 00:04:07,300 inflammatory marker attached to it. 68 00:04:07,600 --> 00:04:11,100 It's made it heavier, It's Made It. 69 00:04:11,100 --> 00:04:15,300 Heavier when you have this inflammatory process in your 70 00:04:15,300 --> 00:04:22,000 body, any inflammatory process in your body, You go for an ESR 71 00:04:22,500 --> 00:04:27,600 because that erythrocyte sedimentation rate is going to 72 00:04:27,600 --> 00:04:31,300 be higher. So that fibrinogen that's 73 00:04:31,300 --> 00:04:35,800 released from inflammation, binds to the red blood cell, 74 00:04:36,400 --> 00:04:40,300 makes it thicker, makes it heavier so that red blood cell. 75 00:04:41,500 --> 00:04:46,900 Drops faster. ESR, it's not a specific test, 76 00:04:47,200 --> 00:04:49,100 but it definitely can let us know. 77 00:04:50,300 --> 00:04:52,900 That we have an inflammatory process in our body. 78 00:04:54,100 --> 00:04:56,500 Real life, right? For those of you that are in the 79 00:04:56,508 --> 00:04:58,800 course. So I say, when I break down labs 80 00:04:58,800 --> 00:05:00,600 and you look at them, you don't want to look at and say, oh 81 00:05:00,600 --> 00:05:03,000 elevated ESR. Oh, they've elevated, limb 82 00:05:03,100 --> 00:05:06,500 lymphocytes, or neutrophils? You know what it means, right? 83 00:05:06,500 --> 00:05:08,100 That's why I'm just come out and do so. 84 00:05:08,100 --> 00:05:12,500 Well, in real life, what are some signs and symptoms that 85 00:05:12,500 --> 00:05:15,900 we're going to see. We got to risk factors great, so 86 00:05:15,900 --> 00:05:17,400 I called applied question right there. 87 00:05:18,600 --> 00:05:21,300 Understanding what we're going to do or what we would expect in 88 00:05:21,300 --> 00:05:25,000 lab values. What are some signs and symptoms 89 00:05:25,200 --> 00:05:26,900 that we're going to see? Well obviously I'm going to see 90 00:05:26,900 --> 00:05:30,100 joint pain but more specifically. 91 00:05:30,500 --> 00:05:32,100 When are we going to see in this joint pain? 92 00:05:35,400 --> 00:05:38,700 In the morning or upon wakening. I do. 93 00:05:38,700 --> 00:05:41,800 I do like that. As a better term. 94 00:05:43,100 --> 00:05:46,000 So upon Awakening, and it lasts more than an hour. 95 00:05:47,500 --> 00:05:53,900 It lasts more than an hour. So you've got this pain morning, 96 00:05:53,900 --> 00:05:58,400 stiffness. And it will improve. 97 00:06:01,900 --> 00:06:07,300 With use, it will improve with use. 98 00:06:08,500 --> 00:06:15,900 It's an inflammatory process. I said osteoarthritis is wear 99 00:06:15,900 --> 00:06:18,800 and tear. Do you think that rheumatoid 100 00:06:18,800 --> 00:06:21,300 arthritis is going to be in one specific joint? 101 00:06:21,300 --> 00:06:22,900 Or do you think it's going to be symmetrical? 102 00:06:23,600 --> 00:06:26,300 That inflammatory process is not going to just attack one of 103 00:06:26,300 --> 00:06:30,100 those joints? It's going after all of them and 104 00:06:30,100 --> 00:06:37,100 it likes to go after certain specific areas in the hand. 105 00:06:37,100 --> 00:06:42,100 And what you'll see is that Ulnar deviation ulnar deviation. 106 00:06:42,400 --> 00:06:48,500 So their hands. Will actually go out words yet. 107 00:06:48,500 --> 00:06:50,500 I'm a horrible jar. This is my. 108 00:06:50,800 --> 00:06:52,700 These are my hands. They're going out like this. 109 00:06:52,700 --> 00:06:58,100 Alright, so you'll see this in this is called ulnar deviation. 110 00:07:00,000 --> 00:07:02,000 We'll also see it's an autoimmune disease. 111 00:07:02,000 --> 00:07:04,500 So we're also going to see systemic issues, right? 112 00:07:05,200 --> 00:07:07,600 And systemic issues that you're going to encounter. 113 00:07:09,000 --> 00:07:15,500 With rheumatoid arthritis. If their bodies becoming 114 00:07:16,500 --> 00:07:18,900 inflamed, their body's under stress, they're going to see 115 00:07:18,900 --> 00:07:22,500 that low grade fever under that 100.4. 116 00:07:27,000 --> 00:07:30,100 If their body is constantly inflamed and that is autoimmune 117 00:07:30,100 --> 00:07:32,600 disease, they're going to be fatigued. 118 00:07:35,800 --> 00:07:37,900 They may even experience weight loss. 119 00:07:42,200 --> 00:07:48,400 So when they wake up, we want to be careful and educate them 120 00:07:48,800 --> 00:07:51,300 because when they wake up they're going to be extremely 121 00:07:51,300 --> 00:07:55,000 stiff. And at night time we want them 122 00:07:55,000 --> 00:08:00,100 laying down straight, don't have their joints bent. 123 00:08:00,100 --> 00:08:02,600 It's going to make the process worse. 124 00:08:03,000 --> 00:08:07,200 So make sure that they are flat. And if they need an immobilizer, 125 00:08:08,200 --> 00:08:11,600 Let them use one at night time because we don't want those 126 00:08:11,600 --> 00:08:19,000 joints to get dysmorphia. That inflammatory process is 127 00:08:19,000 --> 00:08:21,900 going to also cause tissue swelling. 128 00:08:24,400 --> 00:08:28,400 So, all this that's going on. In their body. 129 00:08:28,600 --> 00:08:34,200 Now they wake up and for about our they've got this joint pain, 130 00:08:34,200 --> 00:08:42,000 this stiffness, this fatigue, this swelling Tell them to take 131 00:08:42,000 --> 00:08:49,600 a warm shower in the morning. Or warm bath because we want 132 00:08:49,600 --> 00:08:53,800 those joints to get loose and we want Mobility because it's going 133 00:08:53,800 --> 00:08:56,800 to take them an hour. And we know that if we are able 134 00:08:56,800 --> 00:09:00,100 to have that blood circulation and that Mobility that it will 135 00:09:00,100 --> 00:09:03,100 start to get better and better as time progresses throughout 136 00:09:03,100 --> 00:09:09,100 the day. so, the problem with this is it affects their there, 137 00:09:09,100 --> 00:09:14,200 daily Life right there, active activities of daily living. 138 00:09:15,700 --> 00:09:19,900 What's all this right here are signs and symptoms, perfect, 139 00:09:19,900 --> 00:09:23,500 select all that. Apply question joint pain joint 140 00:09:23,500 --> 00:09:27,400 pain upon Awakening for the first hour morning stiffness 141 00:09:28,100 --> 00:09:32,000 improves with use warm shower or more showers going to be more so 142 00:09:32,000 --> 00:09:34,600 education. They're going to experience 143 00:09:34,600 --> 00:09:38,200 tissue swelling, weight loss, fatigue, fever, under 100.4. 144 00:09:38,600 --> 00:09:42,300 It's going to be symmetric and you'll see that ulnar deviation. 145 00:09:43,300 --> 00:09:46,300 Owner deviation. Now that hand, if you guys have 146 00:09:46,300 --> 00:09:51,600 not seen a picture of somebody rheumatoid arthritis, I want you 147 00:09:51,600 --> 00:09:55,300 to Google it. So with the joints that it's 148 00:09:55,300 --> 00:09:56,900 going to affect. So this is your wrist. 149 00:09:56,900 --> 00:09:58,300 So it's going to affect your wrist. 150 00:09:59,700 --> 00:10:04,500 And then it's going to affect your proximal interphalangeal 151 00:10:04,500 --> 00:10:07,200 joints, which are over here. These are your proximal 152 00:10:07,200 --> 00:10:10,300 interphalangeal joints. These are your distal. 153 00:10:10,600 --> 00:10:14,900 It does not affect your distal and also affects your meta. 154 00:10:15,200 --> 00:10:18,000 Carpal phalangeal joint. Why is that so important? 155 00:10:18,000 --> 00:10:20,700 Because if you just think about this, those joints are going to 156 00:10:20,700 --> 00:10:22,800 now become the tissue around. It's going to be sold in those 157 00:10:22,800 --> 00:10:25,200 joints are to become deformed and their hands are going to go 158 00:10:25,208 --> 00:10:28,400 like this, so their activities of daily living. 159 00:10:30,200 --> 00:10:32,100 It's going to be tough. It's gonna be tough. 160 00:10:32,800 --> 00:10:36,500 And that deformity is also going to affect the mentally, because 161 00:10:36,500 --> 00:10:39,800 now, their body image is changing and that's, it's 162 00:10:39,800 --> 00:10:41,500 something that you're going to see all the time, you can't just 163 00:10:41,500 --> 00:10:44,000 hide it under clothes. So people are going to start to 164 00:10:44,000 --> 00:10:46,600 become self-conscious of it, right? 165 00:10:46,800 --> 00:10:50,200 So very important to understand what's going on here because it 166 00:10:50,200 --> 00:10:52,900 affects a lot of different things moving forward. 167 00:10:53,500 --> 00:10:55,000 So what are we going to do about this? 168 00:10:55,500 --> 00:10:57,200 How are we going to treat this patient? 169 00:10:57,300 --> 00:11:02,300 Got to give them medications. Hey, what's up everyone? 170 00:11:02,300 --> 00:11:06,200 Doctors Deshawn here, NCLEX high yield and this episode is 171 00:11:06,200 --> 00:11:09,500 brought to you by my friends over at Sea Beast at they got 172 00:11:09,500 --> 00:11:12,400 amazing products. Personally personally, I use 173 00:11:12,400 --> 00:11:14,900 their common cream. High anxiety, a lot of workload. 174 00:11:14,900 --> 00:11:17,600 You guys know how much I work. So I love, they're coming cream 175 00:11:17,600 --> 00:11:21,700 and then you guys know I love to play ball so that muscle roll on 176 00:11:21,700 --> 00:11:23,400 is amazing. Amazing amazing. 177 00:11:23,400 --> 00:11:28,400 Definitely check out my friends. Over at CBD stat CBD, stat dot 178 00:11:28,400 --> 00:11:34,800 care. / nhy to get your pre health care or Health Care, work 179 00:11:34,800 --> 00:11:38,100 discount. Start with NSAIDs. 180 00:11:40,400 --> 00:11:42,000 But what do we know about NSAIDs? 181 00:11:44,700 --> 00:11:48,900 Well, we can't chronically take them, we've talked about that, 182 00:11:48,900 --> 00:11:51,000 right? I talked about that a lot with 183 00:11:51,000 --> 00:11:52,800 NSAIDs. We can't chronically, give it 184 00:11:52,800 --> 00:11:58,200 because it decreases that prostaglandin production, which 185 00:11:58,900 --> 00:12:06,600 coats our stomach. and when it decreases that, Prostaglandin, 186 00:12:06,900 --> 00:12:10,500 that lining goes away. And when that lining goes away 187 00:12:11,300 --> 00:12:15,400 acid will eat at the lining and it will create an ulcer. 188 00:12:16,400 --> 00:12:18,600 So we can't clinically take NSAIDs. 189 00:12:20,700 --> 00:12:26,800 And it also causes constriction of the efferent arterioles in 190 00:12:26,800 --> 00:12:29,300 the kidney. So the blood supply in the 191 00:12:29,300 --> 00:12:33,600 kidney is going to be decreased. So now we're going to have Renal 192 00:12:33,600 --> 00:12:36,000 issues. So, watch out for that person, 193 00:12:36,100 --> 00:12:39,100 that's on a chronic NSAIDs because if this person has 194 00:12:39,100 --> 00:12:42,700 rheumatoid arthritis and this is exactly how I would word. 195 00:12:42,700 --> 00:12:45,800 This question person comes in with the history of rheumatoid 196 00:12:45,800 --> 00:12:49,900 arthritis and is that says that I don't need medication, I take 197 00:12:50,200 --> 00:12:52,400 Ibuprofen over-the-counter four times a day. 198 00:12:52,800 --> 00:12:54,200 You're gonna be like wait a minute, which of the following 199 00:12:54,200 --> 00:12:56,800 statements is further teaching for the intervention moment. 200 00:12:57,000 --> 00:13:00,200 100%, you're going to be looking at that because you don't want 201 00:13:00,200 --> 00:13:04,800 them chronically on NSAIDs. it will lead to ulcers or one of 202 00:13:04,800 --> 00:13:08,000 ask graph, which is what Hemorrhage. 203 00:13:08,600 --> 00:13:10,200 Right? You'll see that black tardy 204 00:13:10,200 --> 00:13:14,100 story will start to see that pain so we want to educate them 205 00:13:14,100 --> 00:13:18,300 that NSAIDs are great, temporary relief but ultimately we want to 206 00:13:18,300 --> 00:13:21,900 get them on disease-modifying agents, right? 207 00:13:21,900 --> 00:13:23,400 Or rheumatoid? Yeah, disease. 208 00:13:24,400 --> 00:13:30,300 So, The one that comes up the most in my opinion on the boards 209 00:13:30,300 --> 00:13:33,200 is going to be Methotrexate. So let's get into some pain. 210 00:13:34,100 --> 00:13:39,700 So with Methotrexate it is a folic acid synthesis inhibitor. 211 00:13:40,000 --> 00:13:43,200 That's the reason why I can cause neural tube defects. 212 00:13:44,800 --> 00:13:47,700 Definitely want to educate your patient. 213 00:13:47,700 --> 00:13:52,500 Whoever is on it, that it is a teratogen the lack of folic 214 00:13:52,500 --> 00:13:57,200 acid. Or the production of folic acid 215 00:13:57,400 --> 00:14:01,100 or the conversion of folic acid, that, that, that is decreased. 216 00:14:01,100 --> 00:14:05,000 Because this person is on Methotrexate, can complicate the 217 00:14:05,000 --> 00:14:07,700 pregnancy because it's a teratogen, we're worried about 218 00:14:07,700 --> 00:14:13,700 neural tube defects. so, if a person is on methotrexate, And 219 00:14:13,700 --> 00:14:15,100 this is the way that I would ask him. 220 00:14:15,100 --> 00:14:16,700 I say this all the time to my students. 221 00:14:16,700 --> 00:14:21,200 I go listen, if somebody's on whatever or lets you say forget 222 00:14:21,200 --> 00:14:26,200 the question, okay? If you see in the answer choice, 223 00:14:26,700 --> 00:14:30,400 if you see an answer Choice, check pregnancy, ask him what 224 00:14:30,400 --> 00:14:33,900 the last semesters tide cycle was do a upt doing. 225 00:14:33,900 --> 00:14:38,500 HCG asking, if you're sexually active, why did they put that in 226 00:14:38,500 --> 00:14:40,800 the answer Choice? Well, this is a question that I 227 00:14:40,800 --> 00:14:44,500 would ask. Person wants to ask about 228 00:14:44,500 --> 00:14:46,700 pregnancy and they're currently taking Methotrexate. 229 00:14:47,000 --> 00:14:50,000 What are we gonna do? Well, we're going to stop it. 230 00:14:50,100 --> 00:14:54,300 And what if they got pregnant, while they were on Methotrexate? 231 00:14:54,800 --> 00:14:58,800 We're going to give good. We're gonna give folic acid. 232 00:15:00,600 --> 00:15:03,200 In double the dose. This is not just limited to 233 00:15:03,200 --> 00:15:06,500 Methotrexate. I also talked about this Insight 234 00:15:06,500 --> 00:15:08,800 when we talk about Fina Towing, right? 235 00:15:08,900 --> 00:15:13,500 And what is the normal level of folic acid that we give 400 to 236 00:15:13,500 --> 00:15:17,500 800 micrograms. So if we're going to double 237 00:15:17,500 --> 00:15:22,800 that, make sure you're giving them 800 to 1600 micrograms. 238 00:15:24,900 --> 00:15:27,700 So ask them if they're pregnant, make sure they're not pregnant. 239 00:15:27,700 --> 00:15:31,300 It is a teratogen and so think about this, right? 240 00:15:31,700 --> 00:15:37,900 If it is a teratogen Do you think that if this is a drug 241 00:15:37,900 --> 00:15:42,200 that we can use to get rid of a pregnancy on purpose? 242 00:15:43,500 --> 00:15:45,500 Absolutely. Absolutely. 243 00:15:45,700 --> 00:15:53,400 So now because of its nasty side effect, we can use this drug in 244 00:15:53,400 --> 00:15:58,300 ectopic pregnancies. We can also use this drug to 245 00:15:58,300 --> 00:16:09,100 terminate and have an abortion. Metal track. 246 00:16:09,100 --> 00:16:10,900 See? You gotta tie it all together. 247 00:16:10,900 --> 00:16:14,000 You can't memorize. Yeah, if it's a teratogen. 248 00:16:14,000 --> 00:16:17,000 We can also use it on the flip side to write when you wanted to 249 00:16:17,000 --> 00:16:19,800 eliminate. This is a safe one to learn a 250 00:16:19,800 --> 00:16:21,700 not Auto driver. Genes are going to be good for 251 00:16:21,700 --> 00:16:23,400 terminating pregnancy. This is actually a big one to 252 00:16:23,400 --> 00:16:28,000 terminate pregnancy. This drug is also 253 00:16:29,200 --> 00:16:36,000 hepatotoxicity, and I'm not talking. just like, oh, your 254 00:16:36,000 --> 00:16:41,600 liver, check your liver enzymes, which are what Peyote. 255 00:16:41,600 --> 00:16:44,500 AST, this is severely, I had a toxic. 256 00:16:44,500 --> 00:16:47,000 So this is going to be that further teaching further 257 00:16:47,000 --> 00:16:51,800 intervention moment where it's going to be, oh, you know, I'm 258 00:16:51,800 --> 00:16:53,400 on Methotrexate, whatever they got prescribed. 259 00:16:53,400 --> 00:16:55,800 This and like, yeah, I'm gonna, maybe I won't drink a lot. 260 00:16:55,800 --> 00:16:59,000 I'll just have like one beer, no, no, or like one glass of 261 00:16:59,000 --> 00:17:00,700 wine. No, no further teaching further 262 00:17:00,700 --> 00:17:03,000 intervention further understanding moment because in 263 00:17:03,000 --> 00:17:08,300 this situation, you are going to avoid alcohol. 264 00:17:09,000 --> 00:17:15,400 There are three Drugs. That you need to know to avoid 265 00:17:15,400 --> 00:17:18,400 alcohol that the board's love not decrease, alcohol. 266 00:17:18,800 --> 00:17:23,900 Avoid alcohol metronidazole. So Methotrexate metronidazole. 267 00:17:24,099 --> 00:17:30,800 How about you down iso-ne is it Isoniazid metronidazole and 268 00:17:30,800 --> 00:17:32,800 Methotrexate. Now, these aren't the only ones 269 00:17:32,800 --> 00:17:35,100 that you avoid completely stopped. 270 00:17:35,100 --> 00:17:40,000 Not decrease, not have a sip, not have a glass of void. 271 00:17:40,000 --> 00:17:42,200 These aren't the only ones, but these are the ones that the 272 00:17:42,200 --> 00:17:46,700 board's love asking because they're severely hepatotoxicity. 273 00:17:46,800 --> 00:17:52,900 These two are and metronidazole will cause what's called a die 274 00:17:53,100 --> 00:18:00,500 salt from like reaction. Disulfiram, like reaction, some 275 00:18:00,500 --> 00:18:06,600 other side effects that you can see is some GI distress. 276 00:18:06,600 --> 00:18:10,000 Nausea vomiting, diarrhea. That's shorthand for how you 277 00:18:10,000 --> 00:18:14,000 write that. The other thing with 278 00:18:14,000 --> 00:18:16,400 Methotrexate is it can cause mouth ulcers. 279 00:18:16,900 --> 00:18:18,900 So kind of like at the angle of the mouth to kind of look for 280 00:18:18,900 --> 00:18:21,900 those mouth ulcers. So what are we going to educate 281 00:18:21,900 --> 00:18:27,400 the patient on? Educate them on. 282 00:18:27,400 --> 00:18:31,600 Proper oral. Hygiene propyl or Oral Care. 283 00:18:31,600 --> 00:18:35,000 Exactly. So definitely an educational 284 00:18:36,500 --> 00:18:43,900 point right there as well, too. ultimately, The issue with 285 00:18:43,900 --> 00:18:47,600 Methotrexate or sorry, the issue that we're trying to solve is 286 00:18:47,600 --> 00:18:50,400 what rheumatoid arthritis, which is what autoimmune disease. 287 00:18:51,000 --> 00:18:53,800 So what we're trying to do is suppress it immune system. 288 00:18:55,100 --> 00:18:59,600 So you have to educate this patient to avoid large crowds. 289 00:19:04,800 --> 00:19:12,400 They themselves cannot get live, vaccines nor can they be around 290 00:19:12,900 --> 00:19:19,100 somebody who just received it? Look out for signs of infection. 291 00:19:21,700 --> 00:19:25,500 because this person is not going to be able to fight it off, so 292 00:19:25,700 --> 00:19:31,900 that person that comes in And is on Methotrexate or any other 293 00:19:31,900 --> 00:19:35,200 immunosuppressant starts complaining of that sore throat. 294 00:19:36,400 --> 00:19:41,800 Or maybe they've got some GI distress, maybe they think 295 00:19:41,800 --> 00:19:47,000 they've got the stomach flu or they've got UTI. 296 00:19:49,000 --> 00:19:53,800 That's not just some run-of-the-mill issue that we're 297 00:19:53,808 --> 00:19:56,700 going to deal with here. You got to be able to identify 298 00:19:56,700 --> 00:19:59,200 it. We are freaking out about that 299 00:19:59,800 --> 00:20:04,200 because in a person that is on an immunosuppressant that shows 300 00:20:04,200 --> 00:20:09,400 signs of infection, which one of the eight of ask graph is it 301 00:20:12,500 --> 00:20:17,800 Sepsis exactly sepsis. Hey guys, dr. 302 00:20:17,800 --> 00:20:19,500 Zeeshan here. Thank you so much for joining us 303 00:20:19,500 --> 00:20:21,600 on this podcast. Hope you guys enjoyed it. 304 00:20:21,600 --> 00:20:25,200 If you guys, could, kindly subscribe, leave us some Stars, 305 00:20:25,200 --> 00:20:28,200 whatever you think it's worth and leave us a review. 306 00:20:28,200 --> 00:20:30,300 We always want to get better for you guys and want to keep 307 00:20:30,300 --> 00:20:32,000 putting out this free content for you guys. 308 00:20:32,400 --> 00:20:34,200 Hope you guys enjoyed have a good one. 309 00:20:34,200 --> 00:20:35,900 See you, on the next podcast.