Dampening the inflammatory response Flashcards
The presence of what facilitates response to self antigen in joints?
Tissue damage
APCs
Cytokines
What is 1st line treatment for RA?
NSAIDs
What is 2nd line treatment for RA?
DMARDS
Disease modifying anti rheumatic drugs
Name some examples of DMARDS
Methotrexate Sulfasalazine Gold Penicillamine Hydroxychloroquine Leflunomide
Are DMARDs slow or quick acting?
Slow
When are DMARDs recommended?
Early in disease process
What is methotrexate?
Folate antagonist
How does methotrexate work?
Anti-proliferative effect via inhiition of drihydrofolate reductase
What was methotrexate originally introduced as?
Anti-tumour agent
Is methotrextae effective in RA in high or low doses?
Low
Can resistance to methotrexate develop?
Yes
What are the side effects of methotrexate
Depression of bone marrow.
GI tract damage.
What is sulphasalazine used to treat?
RA
IBD
What does penicillamine cause?
Decreased joint swelling, RF and concentration of APP
What does penicillamine prevent maturation of?
Newly synthesised collagen
What are the side effects of penicillamine?
Taste disturbances, rashes, thrombocytopenia, autoimmune disease
What is hydroxychloroquine used mainly to treat?
Malaria
What does hydroxychloroquine do?
Induce remission but doesnt retard progression of bone damage.
Reduces joint swelling and decreases RF.
What does leflunomide do?
Inhibits orotate dehydrogenase
What is it thought DMARDs do?
Inhibit macrophage activation.
Inhibit cell proliferation.
Decrease release of pro-inflammatory cytokines and reactive oxygen species.
What is 3rd line treatment for RA?
Steroids
When do we use steroids in RA?
During flare upas
What is 3rd/4th line treatment for RA?
Biologicals
Name 2 biologicals used in RA
Infliximab
Adalimumab
When is Adalimumab advised to be given?
When pts have failed to respond to DMARD and other a-TNF
