ARTHRITIS, OSTEOPOROSIS

Question 1

labs to check for RA

Answer 1

• LFTs
• ESR/CRP
• FBCs (lymphocytes/neutrophils/platelet)
• Renal function
• Disease activity scores

Question 2

what injections before RA treatment

Answer 2

Pneumococcal, influenza, Hep B, Varicella

Question 3

methotrexate side effects

Answer 3

GI , alopecia

Question 4

methotrexate how it works

Answer 4

dihydrofolate reductase (DHFR) inhibitor

Question 5

ssz how it works

Answer 5

tnf inhibitors

Question 6

methotrexate bioavailability

Answer 6

high bio at lower doses

Question 7

contraindications to methotrex

Answer 7

pregnancy, liver disease, severe renal impairment, blood dyscrasia

Question 8

leflunomide requirement (renal/hep) and why

Answer 8

hep conversion to active metabolite

long half life 18-19d

Question 9

infliximab dosing regimen

Answer 9

3mg/kg at 0,2 & 6 months, then every 8 weeks
thereafter (can increase up to 10mg/kg)

Question 10

what is tofactinib and how is the dosing regimen

Answer 10

jaki
10mg BD for 8 weeks, maintenance 5mg bd

Question 11

when to transition to moderate therapy for RA (up from infliximab)

what is mod therapy

Answer 11

no clinical improv after 3m monothp w inflix etc

Combination therapy with MTX + bDMARDs/tsDMARDs
preferred

Question 12

when to taper thp

Answer 12

min 6m

Question 13

which should be discon first: ssz or hcq

Answer 13

ssz

Question 14

what to avoid in heart failure

Answer 14

tnf inhibitors

Question 15

what to avoid in lung disease

Answer 15

HCQ, MTX, Leflunomide, SSZ & TNF-alpha

Question 16

when to avoid starting leflunomide

Answer 16

ALT > 2xuln

Question 17

how does leflunomide act as an immunomodulator

Answer 17

inhibits pyrimidine synthesis

Question 18

which RA drugs are safe in pregnancy

Answer 18

sulfasalazine
hydroxychloroquine

Question 19

benefit of hydroxychloroquine over other RA drugs

Answer 19

not associated with infection risk or blood abnormalities