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Fall 2024 > OA and RA treatment > Flashcards

OA and RA treatment Flashcards

1
Q

OA nonpharm treatment

A

Weight loss
Low impact exercise
Physical therapy
Reasonable expectations

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2
Q

OA topical medications

A

Capsaicin
NSAIDs

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3
Q

Topical NSAIDs recommended for

A

over oral NSAIDs for patient >75 years old

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4
Q

Topical Capsaicin pain reduction

A

Reduces pain in approximately 2 weeks but has a burning sensation side effect

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5
Q

Acetaminophen use OA

A

First line for mild osteoarthritis
Max dose 4g/day
Less effective than NSAIDs but safer

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6
Q

NSAIDs use OA

A

More effective than acetaminophen
Less favorable adverse events

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7
Q

How should NSAIDs be used if GI bleed in last 12 months

A

COX2 inhibitor + PPI

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8
Q

What happens when COX2 is inhibited

A

vasoconstriction and platelet aggregation

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9
Q

Warnings with NSAIDs

A

CVD
Renal
GI

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10
Q

Opioid use in OA

A

Do not use routinely
High risk and severity of adverse events outweigh benefit potential

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11
Q

Tramadol safety

A

lower seizure threshold
Limit dose to 50mg every 12 hours in patient with cirrhosis
Avoid ER formulation
Increased risk of serotonin syndrome
BBW: Addiction/Abuse/Misuse

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12
Q

Glucosamine and Chondroitin OA

A

Not routinely recommended

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13
Q

Invasive interventions OA

A

No more than a steroid injection every 3 months
Hyaluronic acid benefit not observed until 4 weeks after injections

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14
Q

RA supportive care

A

NSAIDs and corticosteroids

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15
Q

NSAIDs efficacy RA

A

Do not modify the destruction or progression of RA

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16
Q

CS efficacy RA

A

Short term, low doses, effective for symptom flares

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17
Q

CS adverse effects

A

Hyperglycemia
Hypertension
Weight gain
osteoporosis/fracture risk

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18
Q

What to prescribe with corticosteroids long term

A

Start calcium and vit D
Consider bisphosphonates

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19
Q

Synthetic DMARDs

A

Methotrexate and Hydroxychloroquine

20
Q

Methotrexate for RA

A

First choice for DMARD therapy
Add folic acid

21
Q

Leflunomide efficacy

A

Comparable to methotrexate
Can add to methotrexate to further improve symptoms

22
Q

Leflunomide safety

A

Decreased defense against malignancy
Women planning pregnancy or men planning to father children - discontinue drug
Preexisting liver disease and LFTs 2x upper limit should not receive leflunomide

23
Q

Leflunomide adverse effects

A

Alopecia
Sever hepatotoxicity

24
Q

Sulfasalazine patients to avoid

A

Platelet count <50,000/mm3
LFTs >2x upper limit of normal
Acute Hep B/C

25
Q

Benefit of sulfasalazine

A

Alternative for pregnant women or women planning to become pregnant

26
Q

Hydroxychloroquine efficacy

A

Decreases pain and swelling
Improvement in symptoms in 1-2 months
May take 6 months to see full benefit

27
Q

Hydroxyxhloroquine safety

A

Best safety profile out of all synthetic DMARDs
Potential rare maculopathy

28
Q

Biologic DMARDs

A

Adalimumab (Humira)
Certolizumab Pegol (Cimzia)
Etanercept (Enbrel)
Golimumab (Simponi)
Infliximab (Remicade)

29
Q

TNF inhibitor indications

A

RA
Psoriatic arthritis
Ankylosing spondylitis

30
Q

TNF inhibitor efficacy

A

First line choice biologic DMARD based on ability to improve physical function and delay radiographic changes
Combination with methotrexate yields better outcomes than monotherapy

31
Q

TNF inhibitors adverse effects

A

HA
Injection site reactions

32
Q

ACR recommendations for TNF inhibitors

A

Recommends biologic DMARD after insufficient response to nonbiologic DMARDs

33
Q

Clinical Pearl infliximab

A

Should only be used in combination with methotrexate

34
Q

TNF inhbitor nonadherence concern

A

Increased risk of antibody development leading to loss of effectiveness and/or adverse reactions

35
Q

How long for TNF to work

A

Weeks to months; need additional pain management first 3 months

36
Q

Vaccines and TNF inhibitors

A

Live attenuated not recommended

37
Q

Anakinra (Kineret) efficacy

A

decreases RA symptoms
Not as effective as TNF inhibitors

38
Q

Anakinra safety

A

High dose associated with serious infection

39
Q

Tofacitinib (Xeljanz) efficacy

A

reduce RA symptoms 20-70%

40
Q

Tofacitinib safety

A

Bone marrow suppression
Hepatotoxicity

41
Q

Tofacitinib adverse effects

A

Increased infection risk

42
Q

Biologic DMARD + Synthetic DMARD

A

Safe and acceptable

43
Q

Synthetic DMARD + Synthetic DMARD

A

Safe and acceptable

44
Q

Biologic DMARD + Biologic DMARD

A

Increased risk of severe immunosuppression

45
Q

RA optimizing outcome of treatment

A

Early diagnosis
Goal is remission - no joint symptoms
Corticosteroids to be used as bridge to effective DMARD therapy

Fall 2024 (34 decks)

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