MSK 08

Question 1

Combination traditional DMARDs are more effective than monotherapy?

Answer 1

True

Question 2

Never use biologics in combination.

Answer 2

True

Question 3

What is gold standard for treating RA?

Answer 3

Treat to target

Question 4

MTX is a drug of choice unless?

Answer 4

Contraindicated

Question 5

What is the goal of RA therapy?

Answer 5

Achieve remission
Disease control
Maintain functionality
Improve quality of life

Question 6

What is the rationale for treating RA early?

Answer 6

Save cost and avoid chronic disease progression for a patient.
Avoid joint deformity

Question 7

What is treat to target approach?

Answer 7

Treat early and aggressively until target is reached

And our set target is=>remission

Question 8

Drugs available to treat RA for remission?

Answer 8

Cs DMARDs are 
Methotrexate
Leflunomide 
Sulfasalazine 
Hydroxychloroquine

Biologics-TNF alpha inhibitor

Ts DMARDs are
JAK inhibitor i.e. tofacitinib

Question 9

What is the dose of methotrexate?

Answer 9

Oral dose is 20mg/wk. (REMBER methotrexate are always weekly not daily)
SC dose is 25mg/wk. (SC has less toxicity than oral)

Question 10

What does Folic acid do during methotrexate treatment?

Answer 10

Reduces ADRs

Question 11

Can we give combination biologics together at once?

Answer 11

Never.it is a big no no.

Question 12

Before giving biologics to patient what things need to consider?

Answer 12

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

Question 13

What are the benefits of Biologics?

Answer 13

Rapid suppression
Improve pain and swelling
Improve function
Inhibit bone or joint damage

Question 14

What are the common and serious side effects of Biologics?

Answer 14

Common:
Nausea 
Palpitation
Vomiting
Diarrhoea
Headache
Injections site reaction
Serious but not common:
Bacterial
TB
Leukopenia

Question 15

So how you will apply those therapy for a RA patient?

Answer 15

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

Question 16

What is triple therapy?

Answer 16

Methotrexate+ Hydroxychloroquine+ Sulphasalazine
So, if you start early get better response, they are super effective
Similar effect like MTX + Intercept(biologics)
Triple therapy is cost effective than Etanercept(biologics)

Question 17

Does Patients can have their vaccination while they are on biologics?

Answer 17

It is important that “Life vaccines” must not be administered to patients while patients on biologics therapies.
So, administer 2 weeks or preferably 4 weeks after vaccination