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Rheumatology > Management of Rheumatoid Arthritis > Flashcards

Management of Rheumatoid Arthritis Flashcards

1
Q

What is the key to RA therapy

A

Early and aggressive intervention is the key to obtaining optimal outcomes in the management of RA

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2
Q

What is the aim of RA therapy

A

Effective suppression of inflammation

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3
Q

What will Effective suppression of inflammation achieve in RA treatment

A

It will improve symptoms and prevent joint damage and disability

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4
Q

What are the treatment options available in RA

A

Medicines
Therapies
o Physio/pysch/pharma etc
Surgery

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5
Q

What are the therapeutic categories available in RA

A

NSAID

DMARD - Disease Modifying anti Rheumatic drugs

Biologics

Corticosteroids

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6
Q

What are Disease Modifying anti Rheumatic drugs generally

A

A group of structurally unrelated, typically small molecule drugs which have been demonstrated to have slow onset effect (weeks/months) on disease activity and retard disease progression

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7
Q

What are the DMARDs

A

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide

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8
Q

How does methotrexate work

A

Methotrexate works by interfering with the metabolism of folate and suppressing certain components of the immune system

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9
Q

How is methotrexate taken?

A

It is taken by injection or tablet once a week.

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10
Q

What is also prescribed with methotrexate

A

.Folic acid5mg is also prescribed once a week to betaken on a different dayto the methotrexate.

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11
Q

What are side effects of methotrexate

A
  • Mouth ulcers and mucositis
  • Liver toxicity
  • Pulmonary fibrosis
  • Bone marrow suppression and leukopenia (low white blood cells)
  • It isteratogenic(harmful to pregnancy) and needs to be avoided prior to conception in mothers and fathers
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12
Q

How does Leflunomide work

A

Leflunomide is an immunosuppressant medication that works by interfering with the production ofpyrimidine. Pyrimidine is an important component of RNA and DNA.

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13
Q

What are side effects of Leflunomide

A
  • Mouth ulcers and mucositis
  • Increased blood pressure
  • Rashes
  • Peripheral neuropathy
  • Liver toxicity
  • Bone marrow suppression and leukopenia (low white blood cells)
  • It isteratogenic(harmful to pregnancy) and needs to be avoided prior to conception in mothers and fathers
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14
Q

How does Sulfasalzine work

A

Sulfasalazine works as an immunosuppressive and anti-inflammatory medications. The mechanism is not clear but may be related to folate metabolism.

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15
Q

What are side effects of Sulfasalzine

A
  • Temporary male infertility (reduced sperm count)

* Bone marrow suppression

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16
Q

How does Hydroxychloroquine work?

A

Hydroxychloroquine is traditionally an anti-malarial medication. It acts as an immunosuppressive medication by interfering withToll-like receptors, disrupting antigen presentation and increasing the pH in the lysosomes of immune cells

17
Q

What are side-effects of Hydroxychloroquine

A
  • Nightmares
  • Reduced visual acuity (macular toxicity)
  • Liver toxicity
  • Skin pigmentation
18
Q

What are the biologics generally

A

Typically these are large complex proteins which need to be given parenterally. Compared to traditional DMARD, they work rapidly, are generally well tolerated although with important toxicities (eg infection and come at high cost.

19
Q

What type of biologics are there

A

TNFa inhibitors (x5)

IL-1 inhibitors (Anakinra)

Anti B Cell therapies (CD20, Rituximab)

Anti T Cell therapies (Abatacept)

IL-6 inhibitors (Tocilizumab)

Other

20
Q

What is TNF

A

Tumour necrosis factoris a cytokine involved in stimulating inflammation

21
Q

How do TNF inhibitors work

A

Tumour necrosis factoris a cytokine involved in stimulating inflammation. Blocking TNF reduces inflammation.

22
Q

What are some TNF inhibitors

A 
Adalimumab
Infliximab
Golimumab
Certolizumab pegol
Etanercept
23
Q

What are the monoclonal antibodies to TNF

A

Adalimumab, infliximab, golimumab and certolizumab pegol

24
Q

What are the side effects of anti-TNF drugs

A

Vulnerability to severe infections and sepsis

Reactivation of TB and hepatitis B

25
Q

What is a popular Anti B Cell therapies

A

Rituximab

26
Q

What is Rituximab and how does it work

A

Rituximab is amonoclonal antibodythat targets theCD20 proteinon the surface ofB cells. This causes destruction of B cells. It is used for immunosuppression for autoimmune conditions such as rheumatoid arthritis and cancers relating to B cells.

27
Q

What are side effects of Rituximab

A

Vulnerability to severe infections and sepsis

Night sweats

Thrombocytopenia (low platelets)

Peripheral neuropathy

Liver and lung toxicity

28
Q

What is first line treatment for RA

A

Methotrexate
Sulfasalazine
Leflunomide

(monotherapy)

29
Q

What is 2nd line treatment for RA

A

2 of:

Methotrexate
Sulfasalazine
Leflunomide

30
Q

What is 3rd line treatment for RA

A

Methotrexate and biological therapy

31
Q

What is 4th line treatment for RA

A

Methotrexate and Rituximab

Rheumatology (11 decks)

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