DMARDs

Question 1

what is the use of NSAIDs in RA

Answer 1

-to alleviate symptoms but they don’t slow the progression (no radiological change)

Question 2

What is the use of DMARDs in RA

Answer 2

• alleviate symptoms
• slow the progression - there is radiological evidence to show they cause radiological change no evidence reduces bone erosion

Question 3

DMARDs when should be started and length time to have action

Answer 3

• should be started early as soon as RA detected to preserve as must function as possible within 3 months
• takes about 6 months to have effects so NSAIDS + glucocorticoid should be used also while DMARD is still starting to work

Question 4

What should be done before using DMARDs

Answer 4

• FB, urea + electrolytes for kidney function

Question 5

DMARDS treatment choices

Answer 5

1st line treatment is combination methotrexate and other DMARD + short term Glucocorticoid

if combination inappropriate sue mono-therapy of methotrexate

Question 6

1.Methotrexate mechanism action + main side effect

Answer 6

• DHFR inhibitor this blocks folate pathway prevents DNA synthesis this inhibits cell proliferation = reduces immune system cells decreases inflammation
• once weekly dosage (RA uses lower doses than in anticancer treatment)

side effect:
stomatitis where lining of mouth becomes inflammed, hair loss
folic acid given once weekly to reduce side effects don’t give too much as can stop MTX working as folic acid acts on same active site as MTX

• hepatitis also side effect this is worsened by person having excess alcohol during treatment. patient tested for hepatitis before treatment
• pneumonitis which can cause dyspnea report this
• teratogenic- need a wash up period

Question 7

2. Hyroxy-chloroquine

Answer 7

-drug used for RA based on ideal weight if person is obese not just normal weight

side effect
retinopathy as drug is deposited in the eye so annual eye required with therapy and before therapy

Question 8

3. sulfasalazine

Answer 8

immunosuppressive + antibacterial

side effect
rash + oral ulceration patient should be asked about these

Question 9

4. Gold

Answer 9

sodium aurothiomalate
inhibit antigen processing + inhibit inflammatory pathway

side effect
mucocutaneous - skin rash very itchy

Question 10

5. penicillamine

Answer 10

side effect rashes

Question 11

6. leflunomide

Answer 11

inhibits de nove pyrimidine synthesis
this is the 2nd line drug for those that can’t have MTX

reduces TNFa which activates rank F to cause osteoclast production to cause bone erosion. same as MTX

teratogenic

Question 12

7. immunosuppressants

Answer 12

cyclosporin - inhibit T cell activation
azathiprine- inhibit DNA synthesis

requires monitoring as cause increased risk of infection