57 - RA and Migrane Agents

Question 1

What is rheumatoid arthritis (synovitis)?

Answer 1

• Chronic inflammation results in pain and destruction of bone and cartilage that can lead to severe disability
• Also significant systemic effects

Question 2

What are the stages of RA?

Answer 2

• Initiation phase (nonspecific inflammation)
• Amplification phase (T-cell activation)
• Final stage: Chronic inflammation with tissue injury

Question 3

What are the three categories of drugs used to treat RA?

Answer 3

• NSAIDs
• Glucocorticoids
• Disease-modifying anti-rheumatic drugs (DMARDs)

Question 4

Explain the use of DMARDs

Answer 4

• NSAIDs offer mainly symptomatic relief
• They have little effect on the progression of bone and cartilage destruction
• DMARDs are expensive, but can greatly improve prognosis
• Effects of disease-modifying therapies are slow-acting compared with NSAIDs
• Long-term efficacy of DMARD therapies are controversial

Question 5

What are the two categories of DMARDs?

Answer 5

Synthetic

Biologic
- Organic compounds that are made by living cells AND modify biologic responses (double meaning)

Question 6

What is a migraine?

Answer 6

Symptomatic diagnosis

• At least 5 attacks fulfilling criteria…
• Headache lasts from 4-72 hours
• Headache has at least 2 of the following characteristics: (Unilateral location, pulsating quality, moderate to severe pain intensity, aggravation by or causing avoidance of routine physical activity)
• During headache one of the following: (Nausea and/or vomiting, photophobia and phonophobia)

Question 7

Who are migraines more common in?

Answer 7

Women (3x more common)

It is among the most disabling chronic disorders

Question 8

What causes migraines?

Answer 8

• Primary disorder of the brain

- Neurovascular head ache

Question 9

How does a migraine progress?

Answer 9

• Premonitory phase (prodrome, feeling uneasy, hours)
• Aura (change in visual field, up to 1 hour)
• Headache phase (hours to days)
• Resolution
• Postdrome (hangover, tiredness)

Question 10

How do we non-pharmacologically treat migraines?

Answer 10

• Life style changes
• Avoid triggers (e.g., stress)
• Regular sleep, meals, exercise

Question 11

How do we pharmacologically treat migraines?

Answer 11

Preventative
- Reduce the frequency and severity of attacks

Acute tx

• Non-specific pain meds (Aspirin, acetaminophen, NSAIDs, opiates)
• Specific migraine drugs (Ergotamine, dihydroergotamine, triptans)