MED: Rheumatoid Arthritis

Question 1

What is front-line tx for RA?

Answer 1

Methotrexate (MTX)

Question 2

What are the risks associated w/ MTX?

Answer 2

Toxic build-up d/t kidney dx and thus poor clearance, hepatotoxicity

Question 3

What’s the MOA of MTX? This includes time of onset.

Answer 3

Becomes polyglutaminated over the course of 25-30w leading to:

Inh dihydrofolate reductase AND AICAR Tfase

• DHFR inh > dec purine and pyrimidies (anti-proliferative)
• AICAR Tfase inh > inc adenosine > anti-inflammatory effects

Question 4

What must be taken w/ MTX?

Answer 4

Folate supplement

Question 5

What drugs fall under the Disease Modifying Anti-Rheumatic Drugs (DMARDs)?

Answer 5

MTX
Hydroxycholoroquine
Sulfasalazine
Leflunamide

Question 6

What drugs fall under biological agents? What are their MOAs?

Answer 6

Etanercept: inh TNFa
Infliximab: inh TNFa
Adalimumab: inh TNFa
Anakinra: R agonist that inh IL-1
Certolizumab pegol: inh TNFa
Golimumab: inh TNFa

Question 7

What are the biological agents used for?

Answer 7

Moderate to severe RA, combo’d w/ low-dose MTX

Question 8

If a pt does not respond well for some reason to MTX (intolerance, allergy), what drug is then used? What risks are involved? What’s the MOA?

Answer 8

Tofacitinib

Pt cannot receive vaccines or be around pts who’ve received live vaccines

JAK inh, prevents phosphorylation of STAT which would initiate signaling of gene transcription

Question 9

If a pt presents w/ an acute flare of RA, what’s the tx? Risks involved? MOA?

Answer 9

Corticosteroids until resolved or until MTX/DMARDs can take affect

Steroids are diabetogenic and can also cause Osteoporosis

Inh NF-kB transcription through repression of COX-2 and cytokines inh