OA and RA treatment

Question 1

OA nonpharm treatment

Answer 1

Weight loss
Low impact exercise
Physical therapy
Reasonable expectations

Question 2

OA topical medications

Answer 2

Capsaicin
NSAIDs

Question 3

Topical NSAIDs recommended for

Answer 3

over oral NSAIDs for patient >75 years old

Question 4

Topical Capsaicin pain reduction

Answer 4

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

Question 5

Acetaminophen use OA

Answer 5

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

Question 6

NSAIDs use OA

Answer 6

More effective than acetaminophen
Less favorable adverse events

Question 7

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

Answer 7

COX2 inhibitor + PPI

Question 8

What happens when COX2 is inhibited

Answer 8

vasoconstriction and platelet aggregation

Question 9

Warnings with NSAIDs

Answer 9

CVD
Renal
GI

Question 10

Opioid use in OA

Answer 10

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

Question 11

Tramadol safety

Answer 11

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

Question 12

Glucosamine and Chondroitin OA

Answer 12

Not routinely recommended

Question 13

Invasive interventions OA

Answer 13

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

Question 14

RA supportive care

Answer 14

NSAIDs and corticosteroids

Question 15

NSAIDs efficacy RA

Answer 15

Do not modify the destruction or progression of RA

Question 16

CS efficacy RA

Answer 16

Short term, low doses, effective for symptom flares

Question 17

CS adverse effects

Answer 17

Hyperglycemia
Hypertension
Weight gain
osteoporosis/fracture risk

Question 18

What to prescribe with corticosteroids long term

Answer 18

Start calcium and vit D
Consider bisphosphonates

Question 19

Synthetic DMARDs

Answer 19

Methotrexate and Hydroxychloroquine

Question 20

Methotrexate for RA

Answer 20

First choice for DMARD therapy
Add folic acid

Question 21

Leflunomide efficacy

Answer 21

Comparable to methotrexate
Can add to methotrexate to further improve symptoms

Question 22

Leflunomide safety

Answer 22

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

Question 23

Leflunomide adverse effects

Answer 23

Alopecia
Sever hepatotoxicity

Question 24

Sulfasalazine patients to avoid

Answer 24

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

Question 25

Benefit of sulfasalazine

Answer 25

Alternative for pregnant women or women planning to become pregnant

Question 26

Hydroxychloroquine efficacy

Answer 26

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

Question 27

Hydroxyxhloroquine safety

Answer 27

Best safety profile out of all synthetic DMARDs Potential rare maculopathy

Question 28

Biologic DMARDs

Answer 28

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

Question 29

TNF inhibitor indications

Answer 29

RA Psoriatic arthritis Ankylosing spondylitis

Question 30

TNF inhibitor efficacy

Answer 30

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

Question 31

TNF inhibitors adverse effects

Answer 31

HA Injection site reactions

Question 32

ACR recommendations for TNF inhibitors

Answer 32

Recommends biologic DMARD after insufficient response to nonbiologic DMARDs

Question 33

Clinical Pearl infliximab

Answer 33

Should only be used in combination with methotrexate

Question 34

TNF inhbitor nonadherence concern

Answer 34

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

Question 35

How long for TNF to work

Answer 35

Weeks to months; need additional pain management first 3 months

Question 36

Vaccines and TNF inhibitors

Answer 36

Live attenuated not recommended

Question 37

Anakinra (Kineret) efficacy

Answer 37

decreases RA symptoms Not as effective as TNF inhibitors

Question 38

Anakinra safety

Answer 38

High dose associated with serious infection

Question 39

Tofacitinib (Xeljanz) efficacy

Answer 39

reduce RA symptoms 20-70%

Question 40

Tofacitinib safety

Answer 40

Bone marrow suppression Hepatotoxicity

Question 41

Tofacitinib adverse effects

Answer 41

Increased infection risk

Question 42

Biologic DMARD + Synthetic DMARD

Answer 42

Safe and acceptable

Question 43

Synthetic DMARD + Synthetic DMARD

Answer 43

Safe and acceptable

Question 44

Biologic DMARD + Biologic DMARD

Answer 44

Increased risk of severe immunosuppression

Question 45

RA optimizing outcome of treatment

Answer 45

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