lecture 4 - management of rheumatoid arthritis Flashcards
What class of drugs are used to modify disease progression in RA?
DMARDs
What classes of drugs are used to reduce inflammation in RA treatment?
NSAIDs, Glucocorticoids (steroids)
What classes of drugs are used to control pain in treatment of RA?
Paracetemol, NSAIDs
What NSAIDs are commonly used in RA treatment?
Ibuprofen, diclofenac
Why is aspirin no longer used in RA treatment?
Has a low pKa and therefore the worst gastric adverse reactions of all of the NSAIDs - and others have more potent pain relief properties
Which isoform of COX can be targeted for anti-inflammatory effects?
COX-2
What is the biggest side effect of long term glucocorticoid use?
Cushingoid effects
What is the most widely used glucocorticoid for treatment of RA?
Prednisone
What is bridging therapy in RA?
Using anti-inflammatory, analgesic or immunosupressive drugs to improve quality of life before DMARD therapy has begun to be effective, because it generally has a slow onset of action
What is the first choice DMARD for RA therapy?
Methotrexate
What is the mechanism of action of methotrexate?
Antagonist of folate, which is required for the production of nucleotides and thus DNA in dividing cells. Thus, dividing/progenitor immune cells are targeted, reducing inflammatory responses
What is the most commonly used monoclonal antibody in RA treatment?
Infliximab - a monoclonal antibody against TNF-alpha
When should DMARD treatment be initiated in the course of RA disease progression?
As soon as diagnosis is confirmed to maximise the delay of disease progression
What is the mechanism of action of NSAIDs?
They inhibit cyclooxygenase (COX1/COX2), which reduces prostaglandin synthesis. Prostaglandins are involved in the inflammatory, pain and fever responses. Can also inhibit platelets by inhibiting thromboxane.
