Arthritis

Question 1

RA characteristics

Answer 1

-autoimmune disorder
-bilateral (wrists, fingers, knees, feet, ankles)
-start at any age
-morning stiffness >30 mins
-warm, swollen, puffy jts
-systemic inflammation
-pain worse after periods of inactivity

Question 2

First line of therapy for OA

Answer 2

Acetaminophen

Question 3

Traditional DMARDs (6)

Answer 3

NSAIDs, corticosteroids, hydroxychloroquine, methotrexate, leflunomide, sulfasalazine

Question 4

Biological DMARDs (10)

Answer 4

TNF alpha blockers: etanercept, infliximab, adalimumab, certolizumab, golimumab

Non-TNF alpha biologic: rituximab, abatacept, tocilizumab, baricitinib, anakinra

Question 5

NSAID MOA

Answer 5

COX 1 and 2 inhibition

Question 6

NSAID AR

Answer 6

GI ulceration, bleeding

Question 7

Corticosteroid MOA

Answer 7

Generalized immunosuppression, reduce proinflam cytokines production

Question 8

Corticosteroid AR

Answer 8

Fluid retention, hyperglycemia, wt gain, osteoporosis, and fxs

Question 9

Hydroxychloroquine MOA

Answer 9

Not well understood, maybe immunomodulation

Question 10

Hydroxychloroquine AR

Answer 10

Retinal damage, rash

Question 11

Methotrexate MOA

Answer 11

Inhibits dihydrofolate reductase enzyme, reducing nucleotide synthesis

Slows down immune process —> decreases inflammation

Question 12

Methotrexate AR

Answer 12

Hepatic fibrosis, thrombocytopenia, leukopenia

Question 13

Leflunomide MOA

Answer 13

Inhibits pyrimidine synthesis

Slows down overactive immune cells l

Question 14

Leflunomide AR

Answer 14

Hepatitis

Question 15

Sulfasalazine MOA

Answer 15

Not well understood

Question 16

Sulfasalazine AR

Answer 16

Rash, photosensitivity

Question 17

Etanercept MOA

Answer 17

TNF alpha inhibitor, acts as a circulating receptors to TNF alpha

Question 18

Etanercept AR

Answer 18

Local injection site rxn

Question 19

Infliximab MOA

Answer 19

Chimeric monoclonal antibody targeted against tumor necrosis factor-alpha (TNF alpha)

Question 20

Infliximab AR

Answer 20

Immune reactions, infection, malignancy

Question 21

Adalimumab MOA

Answer 21

Human antibody to TNF alpha

Question 22

Adalimumab AR

Answer 22

Local injection site rxns, infection, malignancy

Question 23

Certolizumab MOA

Answer 23

Humanized antibody specific for human TNF alpha

Question 24

Certolizumab AR

Answer 24

Local injection site rxns, malignancy, injection

Question 25

Golimumab MOA

Answer 25

Human antibody to TNF alpha

Question 26

Golimumab AR

Answer 26

Local injection site rxns, malignancy, infection

Question 27

Rituximab MOA

Answer 27

Depletes peripheral B cells by binding to CD20 protein

Question 28

Rituximab AR

Answer 28

Immune rxns, malignancy, injection

Question 29

Abatacept MOA

Answer 29

Inhibits interactions between antigen-presenting cells and T cells

Question 30

Abatacept AR

Answer 30

Immune rxns, infection, malignancy

Question 31

Tocilizumab MOA

Answer 31

Blocks interleukin-6 receptor

Question 32

Tocilizumab AR

Answer 32

Local injection site rxns, infection, malignancy, GI perforations, thrombocytosis, neutropenia, thrombocytopenia

Question 33

Baricitinib MOA

Answer 33

Janus kinase (JAK) inhibitor

Question 34

Baricitinib AR

Answer 34

Injection, malignancy, hepatotoxicity, anemia, GI perforations, thrombocytosis, neutropenia, increase in SCr and CPK

Question 35

Anakinra MOA

Answer 35

Interleukin-1 receptor anatagonist

Question 36

Anakinra AR

Answer 36

Local injection site rxns, infection, malignancy

Question 37

What are 2 things to keep in mind with pts on DMARDs?

Answer 37

-reduced immune response, more susceptible to infection
-SE fatigue and decreased ex tolerance

Question 38

What is one thing to keep in mind with pts on steroids? What ex beneficial and not?

Answer 38

-demineralization -> increase risk of fxs
-WB ex are good to promote bone density
-high impact need to be modified or avoided