DMARDS Flashcards
Mechanism of anakinra
Competitive IL-1 receptor antagonist
Adverse effects of anakinra
Has short half life and must be taken daily s.c
Mechanism of leflunomide
It suppresses pyrimdine synthesis
Leading to suppression of T cell and B cell function , it is effective as methotrexate in inhibition of bone damage
Mechanism of gold salt
Inhibit function of macrophages and decrease release of cytokines
Which immunosuppressant drugs are taken in RA and what are their mechanism
Cyclophosphamide and azathioprine : suppress immunity by their cytoxic action through variety of mechanisms particularly inhibition of DNA synthesis.
Cyclosporine: potent and specific inhibitor of t helper cell by inhibition ( phosphorylation) of calcineurin that regulates transcription factors in T cell
Mechanism of sulfasalazine
It metabolites into sulphapyridine and 5 asa that causes inhibition of IgA and IgM and supresss T and B cell function
Mechanism of hydroxychloroquine
1- decrease synthesis of Dna and Rna in them
2- decrease T cell response to antigen
3- stabilise lysosomal membrane
Talk about methotrexate
6
1- Its folic acid antagonist
2-With cytoxic and immunosuppressant effect
3-It is one of the first line being used in more than 60% cases
4-It inhibits intracellular enzyemes needed for T cells
5-It given once weekly orally
6-folic acid 5 mg must be given after 24h of methotrexate taken to compensate for folic acid deficiency
Adverse effects of methotrexate
Hepatotoxicity ( common ) and bone marrow suppression, teratogenic and megaloblastic anemia
Talk about bioloic DMARDS TNF-a inhibitors
Adalimumab and infleximab : they are monoclonal antibodies that complex with it and prevents its interactions with T cell and macrophages
Etanercept : it a protein that interferes with it and prevents it from binding to its receptor
Acute and chronic infection , malignancies are contraindications with this group
Because they are expensive, recent guidelines don’t recommend them until at least one non biolgic DMARD usually methotrexate isn’t useful
Symptomatic treatment
NSAIDS : large doses are taken
Corticosteroids
They are given not to prevent but to relief
Diagnosis of RA
Serological: abnormal blood antibodies RF can be found in 80% of cases
Anti CCP antibodies ( anti cylic citrullinated antibodies) , they are more specific and can be detected up to 10 years before development of RA
Joint X ray
Clinical manifestations
Articular : swollen and painful with limited mobility . Symptoms are especially worse in the morning and in late cases forms of deformity are present.
Extra articular : pleural effusion, pericarditis and anemia
Def of RA
Chronic inflammatory disease characteristized by symetric small joint inflammation and deformity . Extra articular manifestations are common
Name all drugs
Anakinra
Leflunomide
Gold salt
Cyclosporine
Cyclophosphamide
Azathioprine
Salfasalazine
Hydroxy chloroquine
Methotrexate
Etanerecpt
Adalimumab
Infleximab
