Approach to Therapeutics in RA

Question 1

drug classes used in RA

Answer 1

NSAIDS
DMARDs
Biologics
Corticosteroids

Question 2

what does DMARD stand for?

Answer 2

disease modifying anti-rheumatic drugs

Question 3

what are DMARDs?

Answer 3

These are a group of structurally unrelated, typically small molecule drugs which have been demonstrated to have slow onset effect on disease activity and retard disease progression. Traditionally, these have been associated with identifiable toxicity profiles and risk of occasional serious adverse event.

Question 4

commonly used DMARDs

Answer 4

methotrexate
sulfasalazine
hydroxychloroquine
leflunomide

Question 5

what is the apprach to management of RA

Answer 5

Early and aggressive intervention is the key to obtaining optimal outcomes in the management of RA. Effective suppression of inflammation will improve symptoms and prevent joint damage and disability

Question 6

treatment strategies in RA

Answer 6

1. Sequential monotherapy
2. Combination: step up, step down and parallel
3. Treat to target

Question 7

what are biologics in relation to RA

Answer 7

Biologic DMARDs have been developed from improved understanding of immunology to target key aspects of inflammatory cascade. Typically, these are large complex proteins which need to be given parenterally. Compared to traditional DMARD, they work rapidly, are generally well tolerated although with important toxicities (e.g. infection) and come at a high cost.

Question 8

name the biologics used in RA

Answer 8

• TNF-𝛼 inhibitors (x5)
• IL-1 inhibitors (Anakinra)
• Anti B cell therapies (CD20, Rituximab)
• Anti T cell therapies (Abatacept)
• IL-6 inhibitors (Tocilizumab)

Question 9

what are the issues with biologics in RA?

Answer 9

• Efficacy: enhanced response when co-prescribed with methotrexate
• Toxicity
o Minor e.g. injection site reaction
o Infection
o ?malignancy
• Cost: £9500