MSK 08 Flashcards
Combination traditional DMARDs are more effective than monotherapy?
True
Never use biologics in combination.
True
What is gold standard for treating RA?
Treat to target
MTX is a drug of choice unless?
Contraindicated
What is the goal of RA therapy?
Achieve remission
Disease control
Maintain functionality
Improve quality of life
What is the rationale for treating RA early?
Save cost and avoid chronic disease progression for a patient.
Avoid joint deformity
What is treat to target approach?
Treat early and aggressively until target is reached
And our set target is=>remission
Drugs available to treat RA for remission?
Cs DMARDs are Methotrexate Leflunomide Sulfasalazine Hydroxychloroquine
Biologics-TNF alpha inhibitor
Ts DMARDs are
JAK inhibitor i.e. tofacitinib
What is the dose of methotrexate?
Oral dose is 20mg/wk. (REMBER methotrexate are always weekly not daily)
SC dose is 25mg/wk. (SC has less toxicity than oral)
What does Folic acid do during methotrexate treatment?
Reduces ADRs
Can we give combination biologics together at once?
Never.it is a big no no.
Before giving biologics to patient what things need to consider?
Rule out previous TB Screen for viral hepatitis Ensure vaccinations are up to date During treatment: CBC & LFT monitor every3-6 months Annual flu shots No live vaccine
What are the benefits of Biologics?
Rapid suppression
Improve pain and swelling
Improve function
Inhibit bone or joint damage
What are the common and serious side effects of Biologics?
Common: Nausea Palpitation Vomiting Diarrhoea Headache Injections site reaction Serious but not common: Bacterial TB Leukopenia
So how you will apply those therapy for a RA patient?
Sequential mono-therapy Step-up combination Combination with DMARDs Combination with biologics So slowly step up and monitor every 1-3 months and apply as long as we do not get remission of OA
