DMARDs for RA

Question 1

Structure, mechansim, and indications of etanercept

Answer 1

Structure- fusion protein (receptor for TNF alpha + Fc portion of IgG)

Mechanism- Binds TNF alpha and neutralizes biological activity

Indications- RA, psoriasis, ankylosing spondylitis

Question 2

Monoclonal antibodies to TNF-alpha (4)

Answer 2

1) Infliximab
2) Adalimumab
3) Certolizumab
4) Golimumab

Question 3

Mechanism + indications of monoclonal antibodies to TNF-alpha

Answer 3

Mechanism: binds TNF-alpha, blocking its activity (binds its receptor)

indications: IBD, RA, ankylosing spondylitis, psoriasis

Question 4

Rituximab mechanism of action + indications

Answer 4

Mechanism: Binds CD 20 (B cell marker)- depletes B cells, decreasing autoimmune response

Indications: RA, Lymphomas, ITP

Question 5

Inhibits binding of CD80/86 (B7) of DCs to CD28 of T cells, preventing T cell activation and lowering immune response in RA

Answer 5

Abatecept

Question 6

Side effects of TNF-alpha inihibitors

Answer 6

Predisposition to infection, including reactivation of latent TB (TNF is important in granuloma stabilization + stabilization)

Question 7

Mechansim of methotrexate, indications, side effecst

Answer 7

Mechanism: Inhibition of pyrimidine synthesis via inhibiting DHFR (inhibits regeneration of THF –> decrease dTMP)

Indications: RA, psoriatic arthritis, immunosuppressive therapy, CAs

Toxicity: myelosuppression

Question 8

Leflunomide mechanism of action, indications, side effects

Answer 8

Mechanism of action: Inhibits pyrimidine synthesis (dihydroorotate dehydrogenase), inhibiting T cell prolifeartion

Indications: RA, psoriatic arthritis

Side effects: Diarrhea, teratogenicitiy , HTN, heptatotoxicity