Disease-Modifying Anti-Rheumatic Drugs Flashcards
3 goals of RA therapy
- Stop Inflammation
- Relieve pain
- Prevent joint/organ damage
Common hand findings in RA
Swan Neck deformity
Boutonniere deformity in the thumb
Ulnar deviation of fingers
Rheumatoid Nodules
First line analgesic choice for RA pain
NSAIDs (aspirin, naproxen, celecoxib)
Prednisone
anti-inflammatory steroid that blocks eicosanoid synthesis.
SE: Immunosuppression, Cushing’s, menstrual irregularity, fluid retention
T/F: Prednisone has a biological effect on tissue
False: it is a prodrug that needs to be converted to prednisolone in the liver
What is the recommended timeline for use of glucocorticoids?
Used <1m more effective than NSAID
Effective for <6m
What would be seen on labs that would indicate RA?
Increased ESR and CRP
+/- Rheumatoid Factor (RF) and CCP-ab depending on severity
Methotrexate
Non-biologic DMARD
Inhibits dihydrofolate reductase- leads to a thymineless death of a cell.
Folate supplementation recommended. Can result in bone marrow suppression, hepatic fibrosis, GI problems
Hydroxychloroquine
alkalizes lysosomes which limits APC interaction with MHC II molecules
SE: retinal damage
Sulfasalazine
Unclear mechanism
Used along with Hydroxychloroquine and Methotrexate in Triple therapy
SE: Sulfa drug
Leflunomide
Inhibits dihydroorotate dehydrogenase and blocks the synthesis of the pyrimidine rUMP
Alternative to Methotrexate
TNF inhibitors
Infliximab
Adalimumab
Etanercept
Anti-CD20 drugs
Rituximab
Ocrelizumab
Abatacept
fusion protein of CTLA-4 and IgG1
Prevents CD28 interaction with CD80/86 which blocks the 2nd signal needed for T cell activation
Tocilizumab
anti-IL6 ab that inhibits JAK-kinase and Ras-signaling
SE: URI
