Management of RA and RA in pregnancy Flashcards
How can flares of rheumatoid arthritis be managed?
Oral or intramuscular steroids
What is now the first line management of rheumatoid arthritis?
DMARD monotherapy +/- a short-course of bridging prednisolone
What is the most commonly used DMARD in the management of rheumatoid arthritis?
Methotrexate
What needs to be monitored when a patient is taking methotrexate?
FBC & LFTs
What are the possible complications of methotrexate?
Myelosuppression (bone marrow suppression and leukopenia)
Liver cirrhosis
Pneumonitis
Teratogenic
Mouth ulcers and mucositis
What other DMARD’s can be used in the management of rheumatoid arthritis?
sulfasalazine
leflunomide
hydroxychloroquine
How is methotrexate administered?
Injection or tablet once a week
Folic acid 5mg is also prescribed once a week to be taken on a different day to the methotrexate.
What is an advantage of sulfasalazine over methotrexate?
Sulfasalazine is not teratogenic and is safe in pregnancy
what should be taken along with sulfasalazine?
Folic acid supplementation
What are potential side effects of sulfasalazine?
Temporary male infertility (reduced sperm count)
Bone marrow suppression
When might TNF-inhibitors be offered in the management of rheumatoid arthritis?
When there is an inadequate response to at least two DMARDs including methotrexate
Which TNF-inhibitors are commonly used in the management of Rheumatoid arthritis?
Etanercept
Infliximab
What type of drug is infliximab?
Monoclonal antibody
What are the main risk factors of etanercept and infliximab?
Immunosuppression
Reactivation of TB
What other medication can be used in the management of rheumatoid arthritis?
Rituximab
What type of medication is rituximab?
Anti-CD20 monoclonal antibody,
How is rituximab administered?
Two 1g intravenous infusions are given two weeks apart
How is the response to treatment monitored in someone with rheumatoid arthritis?
DAS28
What should someone on methotrexate who wants to get pregnant do before conception?
Stop methotrexate at least 6 months before conception
What medications can someone pregnant/ trying to get pregnant not take?
leflunomide
Methotrexate
Which medications are considered safe in pregnancy?
sulfasalazine and hydroxychloroquine
What medication can be used in pregnancy to control flares of RA?
low-dose corticosteroids
How are RA symptoms affected during pregnancy?
RA symptoms tend to improve in pregnancy
Patients tend to have a flare following delivery
Up until when can NSAIDs be used during pregnancy?
NSAIDs may be used until 32 weeks but after this time should be withdrawn due to the risk of early close of the ductus arteriosus
what advice should be given to a patient wanting to get pregnant when RA but has poor control of their symptoms?
patients with early or poorly controlled RA should be advised to defer conception until their disease is more stable
Why do patient need to take folic acid along with methotrexate?
Protect the stomach from GI issue
What needs to be monitored in someone taking methotresate?
FBC
U&E’s
LFT’s
How often do patients need their FBC
U&E’s and LFT’s monitored on methotrexate?
Before starting treatment
Then weekly until established
2-3 months after this
