Arthritis

Question 1

Symptomatic relief for RA

Answer 1

Paracetamol
NSAID
Opiods

Question 2

Non selective NSAIDs

Answer 2

Ibuprofen
Indomethacin
Naproxen

Question 3

COX-2 selective NSAID

Answer 3

Celecoxib

Question 4

Name DMARDS for RA

Answer 4

Methotrexate
Chloroquine
Sulfasalazine

Question 5

How long for DMARDs to show effect

Answer 5

6 weeks to 6 months

Question 6

Max intra-articular steroid injections per year

Answer 6

4

Question 7

MOA od methotrexate

Answer 7

Methotrexate and its active polyglutamate metabolites inhibit the activity of key enzymes such as dihydrofolate reductase, adenosine ribonucleotide transformylase, and thymidylate synthetase:
interferes with several intracellular metabolic processes, in particular:
- one-carbon metabolism
- de novopurine synthesis and
- de novo pyrimidine synthesis

This antimetabolic effect may lead to alteration in intracellular nucleotide pools and increased adenosine release, determining the anti-rheumatic effect of methotrexate

Question 8

CIs for methotrexate

Answer 8

• Pre-existing blood dyscrasias
• Existing renal or hepatic disease
• Previous or existing herpes/varicella infections
• Serous effusions
• Pregnancy or lactation

Question 9

AEs of Methotrexate

Answer 9

Bone marrow suppression
Mucosal ulceration
Hepatotoxicity
Dermatological (Alopecia, Skin rashes, Pigmentations, Urticaria)
Nephropathy
Hyperuricaemia
Other (Headaches, drowsiness, malaise, fatigue, blurred vision)

Question 10

What must be given with methotrexate

Answer 10

Folic acid

Question 11

Interactions with methotrexate

Answer 11

NSAIDs (decreased clearance)

Phenytoin, cotrimoxazole, trimethoprim (additive antifolate activity)