Ch 73 Rheumatoid arthritis

Question 1

The objectives of RA therapy are to:

Answer 1

(1) reduce symptoms (pain, inflammation, stiffness),
(2) maintain joint function and range of motion,
(3) minimize systemic involvement, and
(4) delay disease progression.

Question 2

RA is treated with three classes of drugs:

Answer 2

(1) nonsteroidal anti-inflammatory drugs (NSAIDs);
(2) glucocorticoids; and
(3) disease-modifying antirheumatic drugs (DMARDs).

Question 3

DMARDs can be divided into two groups:

Answer 3

(1) nonbiologic (traditional) DMARDs, which are small molecules produced by conventional chemical techniques; and
(2) biologic DMARDs, which are large molecules produced by recombinant DNA technology.

Question 4

NSAIDs act quickly to relieve symptoms, but do not prevent __.

Answer 4

joint injury and do not delay disease progression

Question 5

__ act quickly and may delay disease progression.

Answer 5

Glucocorticoids

Question 6

DMARDs delay disease progression and reduce joint injury, but __.

Answer 6

onset of benefits is delayed

Question 7

In the past, treatment of RA was initiated with NSAIDs
alone; DMARDs were added only after NSAIDs could no
longer control symptoms. Today, guidelines recommend
initiating:

Answer 7

DMARDs within 3 months of RA diagnosis; the rationale is to delay joint degeneration and delay disease progression.

During the DMARD latency period, NSAIDs (and sometimes glucocorticoids) are used to control symptoms.

Question 8

__ are much safer than glucocorticoids and DMARDs.

Answer 8

NSAIDs

Question 9

Because glucocorticoids cause serious toxicity when used long term, they are generally reserved for short-term use to:

Answer 9

(1) control symptoms while responses to DMARDs are developing or
(2) supplement other drugs when symptoms flare.

Question 10

Second-generation NSAIDs (COX-2 inhibitors, or coxibs) may cause __ than first-generation NSAIDs, but are more expensive.

Answer 10

less GI ulceration

Question 11

The doses of NSAIDs used for RA are __ than the doses used to relieve pain or fever.

Answer 11

much higher

Question 12

__ acts relatively quickly and is considered the DMARD of first choice by most rheumatologists.

Answer 12

Methotrexate (a nonbiologic DMARD)

Question 13

__ neutralizes TNF and thereby suppresses the autoimmune attack on joints.

Answer 13

Etanercept (a biologic DMARD)

Question 14

Etanercept and other TNF antagonists pose a significant

risk for:

Answer 14

serious infections (e.g., bacterial sepsis, invasive
fungal infections, TB, HBV infection), and are associated
with rare cases of heart failure, liver failure, hematologic
disorders, neurologic disorders, severe allergic reactions, and cancer.