6.3. Rheumatology - Therapeutics

Question 1

What are the 4 Categories of Treatment for Rheumatoid Arthritis?

Answer 1

1. Medicines
2. Injections
3. Therapies
4. Surgery

Question 2

What are the Medication Categories, for treating Rheumatoid Arthritis?

Answer 2

1. Non-Steroidal Anti-Inflammatory Drugs (NSAID’s)
2. Disease Modifying Anti-Rheumatic Drugs (DMARD’s)
3. Biologics
4. Corticosteroids

Question 3

What are Disease Modifying Anti-Rheumatic Drugs (DMARD’s)?

Answer 3

A group of drugs which have been demonstrated to have slow-onset effect on disease activity, and retard disease progression

Question 4

What is contained in Disease Modifying Anti-Rheumatic Drugs (DMARD’s)?

Answer 4

1. Methotrexate
2. Sulfasalazine
3. Hydroxychloroquine
4. Leflundomide

Question 5

How should you approach management of Rheumatoid Arthritis?

Answer 5

Early and Aggressive Intervention is Key

Question 6

Why is Methotrexate used in the treatment of Rheumatoid Arthritis?

Answer 6

1. Its effective
2. It is well tolerated
3. It is cheap
   Note - it is the cornerstone of combination treatment (with DMARD and Biologics)

Question 7

What do Biologic DMARD’s target?

Answer 7

Key aspects of the Inflammatory Cascade

Question 8

What is the advantages / disadvantages of Biologic DMARD’s, over traditional DMARD’s?

Answer 8

Advantages:
1. They work rapidly
2. They are well tolerated
Disadvantages:
1. There are important toxicities (i.e. infection)
2. They come at a high cost

Question 9

What Biologic DMARD’s are available?

Answer 9

1. TNF-alpha Inhibitors
2. IL-1 Inhibitors
3. Anti B-Cell Therapies
4. Anti T-Cell Therapies
5. IL-6 Inhibitors

Question 10

What are the issues with Biologic DMARD’s?

Answer 10

1. Efficacy - Enhanced response when co-prescribed with Mtx
2. Toxicity - Injection site reaction / Infection / (Malignancy?)
3. Cost (£9500 vs £50)

Question 11

By what method can Corticosteroids be administered?

Answer 11

1. Orally
2. I-A Injection
3. Intra-Muscular Injection
4. I.V. Infusion

Question 12

What is taken into consideration whilst prescribing Corticosteroids for Rheumatoid Arthritis?

Answer 12

Short Term Benefit
VS
Long Term Toxicity
Note - This is rarely appropriate as a single drug therapy

Question 13

What are the Treatment Strategies for Rheumatoid Arthritis?

Answer 13

1. Sequential Monotherapy
2. Conination
3. a) Step Up
4. b) Step Down
5. c) Parallel
6. Treat to Target