Arthritis and Gout Lecture Flashcards
Is rheumatoid arthritis more common in women or men?
Women 2-3x
What are the major inflammatory cells and cytokines that play a role in rheumatoid arthritis?
CD4 + T cells
TNF alpha and IL-1 (released by macrophages)
What are the main destructive factors in rheumatoid arthritis?
Matrix metalloproteinases.
What are type A and B synoviocytes?
Type A are specialized macrophages
Type B are similar to fibroblasts and secrete hyaluronic acid
How long does it take for the effect of DMARDs to kick in?
2-6 weeks
What is the GOLD standard DMARD?
Methotrexate
What are two ways in which clucocorticoids suppress inflammation associated with rheumatoid arthritis?
Inhibit phospholipase A2 activity which decreases arachidonic acid and thus prostaglandins. They also inhibit the production of a number of cytokines (TNF alpha and IL1) which prevents the induction of COX-2
What are the disabling side effects of prolonged glucocorticoid use?
hyperglycemia, osteoporosis, poor wound healing
How doe antimalarial drugs help treatment of rheumatoid arthritis and SLE?
inhibition of chemotaxis
How does sulfasalazine help in rheumatoid arthritis?
Inhibits IL1 and TNF alpha release
What is the principle mechanism of action of methotrexate at the doses given for rheumatoid arthritis?
inhibition of AICAR transformylase and thymidylate synthetase, with secondary effects on PMN chemotaxis. AMP accumulates is converted to adenosine which is a potent inhibitor of inflammation
What is the current approach to therapy with RA patients who have early RA with low disease activity?
may be treated with nonbiologic DMARD monotherapy
What is the current approach to therapy with RA patients who have moderate or high disease activity but without poor prognostic features?
may receive initial treatment with DMARD monotherapy or the combination of methotrexate and hydroxychloroquine
What is the current approach to therapy with RA patients who have moderate to high disease activity and evidence of poor prognostic features?
may receive combination therapy with methotrexate and hydroxychlorquine and/or sulfasalazine
What is the current approach to therapy with RA patients who have high disease activity and features of poor prognosis?
Started on anti TNF therapy with or without methotrexate
