Management of RA and RA in pregnancy

Question 1

How can flares of rheumatoid arthritis be managed?

Answer 1

Oral or intramuscular steroids

Question 2

What is now the first line management of rheumatoid arthritis?

Answer 2

DMARD monotherapy +/- a short-course of bridging prednisolone

Question 3

What is the most commonly used DMARD in the management of rheumatoid arthritis?

Answer 3

Methotrexate

Question 4

What needs to be monitored when a patient is taking methotrexate?

Answer 4

FBC & LFTs

Question 5

What are the possible complications of methotrexate?

Answer 5

Myelosuppression (bone marrow suppression and leukopenia)
Liver cirrhosis
Pneumonitis
Teratogenic
Mouth ulcers and mucositis

Question 6

What other DMARD’s can be used in the management of rheumatoid arthritis?

Answer 6

sulfasalazine
leflunomide
hydroxychloroquine

Question 7

How is methotrexate administered?

Answer 7

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.

Question 8

What is an advantage of sulfasalazine over methotrexate?

Answer 8

Sulfasalazine is not teratogenic and is safe in pregnancy

Question 9

what should be taken along with sulfasalazine?

Answer 9

Folic acid supplementation

Question 10

What are potential side effects of sulfasalazine?

Answer 10

Temporary male infertility (reduced sperm count)
Bone marrow suppression

Question 11

When might TNF-inhibitors be offered in the management of rheumatoid arthritis?

Answer 11

When there is an inadequate response to at least two DMARDs including methotrexate

Question 12

Which TNF-inhibitors are commonly used in the management of Rheumatoid arthritis?

Answer 12

Etanercept
Infliximab

Question 13

What type of drug is infliximab?

Answer 13

Monoclonal antibody

Question 14

What are the main risk factors of etanercept and infliximab?

Answer 14

Immunosuppression
Reactivation of TB

Question 15

What other medication can be used in the management of rheumatoid arthritis?

Answer 15

Rituximab

Question 16

What type of medication is rituximab?

Answer 16

Anti-CD20 monoclonal antibody,

Question 17

How is rituximab administered?

Answer 17

Two 1g intravenous infusions are given two weeks apart

Question 18

How is the response to treatment monitored in someone with rheumatoid arthritis?

Answer 18

DAS28

Question 19

What should someone on methotrexate who wants to get pregnant do before conception?

Answer 19

Stop methotrexate at least 6 months before conception

Question 20

What medications can someone pregnant/ trying to get pregnant not take?

Answer 20

leflunomide
Methotrexate

Question 21

Which medications are considered safe in pregnancy?

Answer 21

sulfasalazine and hydroxychloroquine

Question 22

What medication can be used in pregnancy to control flares of RA?

Answer 22

low-dose corticosteroids

Question 23

How are RA symptoms affected during pregnancy?

Answer 23

RA symptoms tend to improve in pregnancy
Patients tend to have a flare following delivery

Question 24

Up until when can NSAIDs be used during pregnancy?

Answer 24

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

Question 25

what advice should be given to a patient wanting to get pregnant when RA but has poor control of their symptoms?

Answer 25

patients with early or poorly controlled RA should be advised to defer conception until their disease is more stable

Question 26

Why do patient need to take folic acid along with methotrexate?

Answer 26

Protect the stomach from GI issue

Question 27

What needs to be monitored in someone taking methotresate?

Answer 27

FBC U&E's LFT's

Question 28

How often do patients need their FBC U&E's and LFT's monitored on methotrexate?

Answer 28

Before starting treatment Then weekly until established 2-3 months after this