Drugs for Rheumatoid Arthritis

Question 1

Classes of drugs used in R.A.

Answer 1

NSAIDS, Glucocorticoids, and DMARDs

Question 2

Indications of NSAIDs in R.A.

Answer 2

Reduce pain and inflammation

Question 3

Indications of Oral corticoids in R.A.

Answer 3

Relieve joint symptoms and control systemic manifestations; chronic use may cause many complications

Question 4

True or False: NSAIDs and corticosteroids do not prevent disease progression or joint destruction.

Answer 4

True

Question 5

Which group of drugs used in R.A. can reduce or prevent joint damage?

Answer 5

DMARDs

Question 6

MOA of DMARDs

Answer 6

Delay and possible stop disease progression, but no immediate analgesic effects

Question 7

Time-line of DMARD effects

Answer 7

6 weeks - 6 months

Question 8

First DMARD usually prescribed for mild, moderate, or severe R.A.

Answer 8

Methotrexate

Question 9

When are biologic DMARDs used?

Answer 9

Moderate to severe R.A.

Question 10

AE of Methotrexate in R.A. use

Answer 10

Minimized because doses are much lower than when used for chemotherapy

Question 11

Used in combination therapy with Methotrexate for R.A. in patients who do not respond to Methotrexate alone

Answer 11

Leflunomide; as effective as Methotrexate at reducing disease activity and progression

Question 12

Least toxic of all DMARDs

Answer 12

Hydroxychloroquine

Question 13

Least effective as mono therapy for R.A.; usually combined with Methotrexate and Sulfasalazine

Answer 13

Hydroxychloroquine

Question 14

Moderately effective against mild R.A. and may take 3-6 months to show effects

Answer 14

Hydroxychloroquine

Question 15

Sulfa drug use in R.A.; benefits show after 2-3 months

Answer 15

Sulfasalazine

Question 16

Limited use in R.A. due to nephrotoxicity and food and drug interactions

Answer 16

Cyclosporine

Question 17

Used for refractory R.A.

Answer 17

Azathioprine

Question 18

Use in R.A. limited to most severe cases due to increased risk of infection and malignancy

Answer 18

Cyclophosphamide

Question 19

Non-Biological DMARDs

Answer 19

Methotrexate, Leflunomide, Hydroxychloroquine, Sulfasalazine, Cyclosporine, Azathioprine, and Cyclophosphamide

Question 20

Biologic DMARDs

Answer 20

Adalimumab, Infliximab, Etanercept, Anakinra, Rituximab, and Abatacept

Question 21

Anti-TNF DMARDs

Answer 21

Adalimumab, Infliximab, and Etanercept

Question 22

Which TNF is most important in inflammatory process of R.A.?

Answer 22

TNF-alpha

Question 23

TNF inhibitors can be combined with drug to cause synergistic effects?

Answer 23

Methotrexate i.e. Methotrexate + Rituximab

Question 24

True or False: TNF inhibitors act more quickly than non-biologic DMARDs.

Answer 24

True

Question 25

Effective in patients who did not respond to non-biologic DMARDs or anti-TNF agents

Answer 25

Abatacept

Question 26

Biologic DMARD approved for moderate to severe R.A.

Answer 26

Anakinra; modest effects

Question 27

Mainly used as bridge drugs for symptom relief

Answer 27

NSAIDs

Question 28

Indications for Glucocorticoids in R.A.

Answer 28

Short courses at low doses for symptomatic relief until effects of DMARDs kick in; intra-articular injection for relieve of acutely inflammated R.A. joint

Question 29

Initial Treatment of R.A.

Answer 29

Non-biologic DMARD (Methotrexate) + NSAID or corticoid for symptom control

Question 30

Treatment for mildest cases of R.A.

Answer 30

Hydrochloroquine and Sulfasalazine

Question 31

1st line treatment of moderate to severe R.A.

Answer 31

TNF inhibitors

Question 32

Combination therapy in R.A.

Answer 32

Weekly Methotrexate + other agent

Hydroxychloroquine + Methotrexate and Sulfasalazine

Question 33

AE of combination therapy

Answer 33

Leflunamide + Methotrexate increases hepatotoxicity; monitor closely

Question 34

Effective combination therapies

Answer 34

Methotrexate +

Hydroxychloroquinolone + Sulfasalazine or individually
Cyclosporine
Leflunomide
TNF Inhibitor