Osteoarthritis and Rheumatoid arthritis Flashcards
What is osteoarthritis?
Degeneration of cartilage in joints resulting in pain and disability. This most commonly occurs in the knees, hips, and hands. Most of the treatments do not change the progression or course of the disease but rather just relieves the patient of their symptoms.
What drugs are used to treat osteoarthritis?
Acetaminophen NSAIDs Duloxetine Tramadol Opioids Capsaicin Intraarticular Corticoids
What is the role of acetaminophen in the treatment of osteoarthritis?
Acetaminophen is generally the first-line treatment for mild to moderate osteoarthritic pain without signs or symptoms of inflammation. [the most common form of osteoarthritis lacks inflammation so as long as there is no inflammation this is the rug to use]
Acetaminophen is less effective than a full dose of NSAIDs, but it does have fewer adverse effects (esp GI), which is why it is the gold standard.
*only if there is inflammation and acetaminophens are not controlling pain should an NSAID be used.
What is the role of Diclofenac in the tx of osteoarthritis?
Diclofenac is an NSAID that is used in the treatment of osteoarthritis. It is available as a topical gel or solution to localize the treatment and joints affected. Because this medication is rubbed on the individual joint, there is less risk of systemic adverse effects.
Other than NSAIDs and acetaminophen, what other drugs can be used to treat osteoarthritis?
- Duloxetine - selective serotonin and NE reuptake inhibitor used to treat chronic musculoskeletal pain [no GI side effects]
- Tramadol - approved for treatment of moderate to moderate severe chronic pain in adults
- Opioids - last resort for the treatment of intractable osteoarthritis pain [includes hydrocodone, morphine and oxycodone]
- Capsaicin - topical application that reduces osteoarthritic pain, but may cause severe skin burns that cause nerve damage. When the ointment dries, it may also become airborne and cause coughing, sneezing, and eye irritation.
- Intraarticular corticosteroids - used for persistent symptoms in one of a few affected joints [most commonly used are betamethasone and triamcinolone]
What is Rheumatoid arthritis?
Autoimmune disease drive by activated T cells. The activation of T cells lead to the release of IL-1 and TNF.
What are the three classes of drugs used to treat RA?
- NSAIDs - short onset, offers symptomatic relief by reducing inflammation and pain as well as preserving function, there is NO prevention of disease progression
- glucocorticoides - short onset, there is no prevention of disease progression
- DMARDs - several weeks to months to take effect, may reduce or prevent joint damage by stopping progression of the disease [ex. Methotrexate]
What is the first DMARD prescribed for RA?
Methotrexate - used for mild, moderate or severe RA. This drug is also used in the treatment of cancer chemotherapy, but a much smaller dose is required for RA, therefore adverse effects are minimized along with it.
What are the different non-biological vs biological DMARDs?
Non-biological
- Methotrexate
- Leflunomide
- Hydroxychloroquine
- Sulfasalazine
- Cyclosporine
- Azathioprine
- Cyclophosphamide
Biological
- Anti-TNFa drugs [Adalimumab, Infliximab, Etanercept]
- Anakinra
- Rituximab
- Abatacept
What is Leflunomide for RA?
Non-biological DMARD that is as effective as methotrexate at reducing disease activity and progression. Pts who do not respond to methotrexate alone may benefit from combination therapy with Leflunomide and Methotrexate – this combination increases risk of hepatotoxicity, so watch out!
What is Hydroxychloroquine for RA?
Moderately effective for mild RA and is usually well tolerated. It has the least toxicity of any DMARD but is also the least effective as monotherapy. It is often used with methotrexate and sulfasalazine. The drugs effectiveness may required 3-6 months to become apparent.
What is the role of Sulfasalazine in RA tx?
Effective in RA but takes about 2-3 months to become apparent.
What is the role of cyclosporine in RA tx?
Helping in some pts with RA, but nephrotoxicity and many interactions with drugs and foods have limited its use.
What is the role of Azathioprine in RA rx?
Used in pts with refractory RA or systemic involvement such as rheumatoid vasculitis.
What is the role of cyclophosphamide?
limited to severe cases of RA with systemic features such as vasculitis. Long-term use increases risk of infection and malignancy. Only oral form of the drug is used to treat RA.
