0727 - Drugs in Arthritis

Question 1

What is a DMARD?

Answer 1

Disease-modifying anti-rheumatic drug. Cornerstone of RA treatment regardless of which stage of the disease. Methotrexate most important. Alters natural history of RA, preventing further progression, so hit hard and early with it.

Question 2

What is RA?

Answer 2

Autoimmune disease involving multiple organ systems but primarily characterised by inflammation of the synovial membrane lining the joints causing joint damage from bone erosion, resulting in pain, stiffness, and swelling which, with extra-articular features ultimately leads to irreversible joint destruction, disability and premature death.

Question 3

What are the criteria for diagnosing RA?

Answer 3

4 out of these 7:
Morning stiffness of joints of more than 1hr
Arthritis in 3+ areas
Arthritis of hand joints
Symmetric involvement
Rheumatoid nodules
CCP-antibody positive
Radiographic changes

Question 4

What are some poor prognostic factors in RA?

Answer 4

Female
Polyarthritis
Elevated CRP and ESR
Erosions
Extra-articular disease (nodules, vasculitis)
CCP-antibody positive
High RF

Question 5

What are some common side effects with DMARDs?

Answer 5

Hepatotoxicity, myelotoxicity

Methotrexate - fibrosing alveolitis.

Question 6

What are some common side effects with biologic agents used in RA?

Answer 6

Reactions, infections.

Question 7

What is the gold standard DMARD for treating RA?

Answer 7

Methotrexate.

Question 8

Outline ‘treat to target’. How is this measured?

Answer 8

Goal is remission - know what you are actually trying to achieve (aim/target) when you are treating rather than just hitting it. Review regularly, and add in more treatments if you’re not hitting the target.
Disease Activity Score (DAS)28 is the standard rating system - Based on joints, patient experience, CRP. Goal is