Clinical Aspects of RA and Approach to Therapeutics Flashcards
RA: Therapeutics
What ar ethe different kinds of Treatment of Inflammatory Arthritis?
Medicines
Injections (steroid)
Therapies
Surgery
what are some different kind of medicines that are used?
1) Non steroidal anti inflammatory drugs (NSAID) (symptoms controlling, try minimise the use of these)
2) Disease Modifying anti Rheumatic drugs (DMARD)
3) Biologics
4) Corticosteroids (oral, i-m, i-a)
what are Disease Modifying Anti Rheumatic Drugs (DMARD) (conventional, non biologic DMARD)?
A group of structurally unrelated, typically small molecule drugs which have been demonstrated to have slow onset effect on disease activity and retard disease progression. Traditionally, these have been associated with identifiable toxicity profiles and risk of occasional serious adverse event
what DMARDare used and not used?
used:
Methotrexate (gold standard)
Sulfasalazine
Hydroxychloroquine
Leflunomide
not used:
Gold salts (i-m, oral)
Penicillamine
Others
what is the Approach to management of IJD(RA)?
Early and aggressive intervention is the key to obtaining optimal outcomes in the management of RA
Effective suppression of inflammation will improve symptoms and prevent joint damage and disability
How early and how aggressive
What’s so special about Methotrexate?
Effective, well tolerated and cheap!
Cornerstone of combination treatment (with DMARD and biologic)
People stay on it
in terms of Early and Aggressive Treatment of RA, how is it done?
Treatment Strategies
Sequential Monotherapy
Combination: step up, step down and parallel
Treat to Target
(more aggressive aproach makes the diseases better)
how are biologics used in arthritis?
Biologic DMARDs have been developed from improved understanding of immunology to target key aspects of inflammatory cascade. Typically these are large complex proteins which need to be given parenterally. Compared to traditional DMARD, they work rapidly, are generally well tolerated although with important toxicities (eg infection and come at high cost.
what are some biologics used in 2020?
TNFa inhibitors (x5)
IL-1 inhibitors (Anakinra)
Anti B Cell therapies (CD20, Rituximab)
Anti T Cell therapies (Abatacept)
IL-6 inhibitors (Tocilizumab, Sarilumab)
Oral kinase inhibitors
Other
(Large difference in structure, Very complex so hard to manufacture so expensive)
what are some issues with biologics?
Efficacy: enhanced response when co prescribed with Mtx
Toxicity: minor eg injection site reaction
Infection
?Malignancy
Cost: £9500 v £50
how are corticosteroids used?
Corticosteroids can be prescribed by mouth, by i-a or i-m injection and by i-v infusion
Short term benefit v long term toxicity
Rarely appropriate as single drug therapy
Conclusion:
RA is a severe disease associated with disability, high personal and societal costs and premature _____
Effective use of modern therapeutics inc traditional and biologic DMARD has transformed _________.
Effective therapeutics are part of overall care plan which includes multi ___________ input and management of co morbidities
death
outcomes
professional
