Management of RA

Question 1

What are the 2 goals for drug treatment for a patient with RA

Answer 1

Decrease joint inflammation
Decrease or stop the progression of the disease

Question 2

What are the 3 categories of drugs that are used to treat RA?

Answer 2

NSAIDs, glucocorticoids, DMARDs

Question 3

T/F NSAIDs including COX-2 inhibitors usage for treating RA has declined since DMARDs, but still play an important role

Answer 3

True

Question 4

Why are NSAIDs still prescribed for patients with RA?

Answer 4

to reduce inflammation and pain management

Question 5

What drug is used with early progression of RA, can decrease joint erosion, and damage?

Answer 5

Glucocorticoids & DMARDs

Question 6

Why might a patient start on a glucocorticoid while also taking a DMARD?

Answer 6

DMARDs take several weeks to become effective so using a glucocorticoids initially with a DMARD can help control pain and inflammation until the DMARD takes effect

Question 7

T/F Glucocorticoids can be used during acute flare-ups or exacerbations of RA or even injured directly into a joint to manage exacerbations

Answer 7

True

Question 8

How do glucocorticoids work?

Answer 8

Bind to receptor in the cytoplasm of certain cells and form a glucocorticoid receptor complex. the complex then moves to the cell’s nucleus where it binds to genes that regulate the inflam process by inhibiting the production of pro inflam substances and production of anti-inflam proteins occurs

Question 9

List 6 major side effects of taking glucocorticoids

Answer 9

Osteoporosis – especially when used at higher doses for prolonged periods of time
Muscle wasting and weakness
HTN
Aggravation of DM
Glaucoma
Cataracts
Increased risk of infection

Question 10

What is a nonbiological traditional DMARDs and why might it be used?

Answer 10

Antimalarials (hydroxychloroquine) - an option for those that cannot tolerate other DMARDs

Question 11

How does Antimalarials (hydroxychloroquine) work?

Answer 11

These drugs work by affecting immune cell responses

Question 12

What are the major side effects of Antimalarials (hydroxychloroquine)?

Answer 12

High doses can cause irreversible retinal damage (Recommend regular eye exams for patients)
Small risk of headache and GI distress

(Considered very safe compared to other DMARDs)

Question 13

What was the first drug found as DMARDs and how does it work?

Answer 13

Gold compounds – bind to enzymes in immune cells which suppresses the ability for autoimmune responses

Question 14

When would gold compounds be used to treat someone with RA and why?

Answer 14

Used only for patients who don’t respond to other DMARDs - suppresses the immune system long term, so dont use as often

Question 15

Biological DMARDs use what type of inhibitors and how do they work?

Answer 15

tumor necrosis factor inhibitors (TNF) – blocks TNF-alpha, which is released during the inflam process & promotes joint erosion & inflammation with RA

Question 16

What are the only 2 ways Biological DMARDs can be given to a patient?

Answer 16

subcutaneous injection or by slow IV fusion

Question 17

What is a contraindication for prescribing a biological DMARD?

Answer 17

Contraindicated in people who have infections

Question 18

If a patient is not responding well to traditional DMARDs, what could a physician prescribe and what are the dangers of it?

Answer 18

Other DMARDs that are more toxic

Question 19

Why might a physician prescribe methotrexate for a patient with RA and what is the ideal timeline for length of taking the medication?

Answer 19

it slows the effects of RA and has a greater therapeutic effect than other DMARDs with a rapid onset of 2-3 weeks ONLY due to being a very toxic drug

Question 20

What is the cornerstone drug used in combination with other DMARDs?

Answer 20

Methotrexate often combined with TNF-alpha

Question 21

Why might a physician choose to use a combination of DMARDs to treat a patient with RA and what is the risk?

Answer 21

A combination of 2 or more drugs can have optimal benefits and a low dose can be used of each & may provide the best success through RA remission
Increased potential for toxicity and drug interaction when combining DMARDs

Question 22

What are 3 things you would recommend to a patient with RA pertaining to diet?

Answer 22

Suggest: high in fish oral and omega-3 fatty acids to control inflammation, antioxidant properties, and AVOID high meat and proteins as well as smoking