Pharmacology

Question 1

What are the side effects of leflunomide? And monitoring?

Answer 1

GI - diarrhoea
Hypertension 
Weight loss
Peripheral neuropathy 
Myelosupprssion
Pneumonitis 
Liver impairment 

Monitoring
Fbc and LFT, and bp

Question 2

Side effects of sulfasalizine

Answer 2

Rashes
Oligospermia
Heinz body anaemia/ myelosuppression
Interstitial lung disease/ fibrosis

Question 3

Side effects of hydroychloroquine

Answer 3

Retinopathy

Corneal deposits

Question 4

When to start someone with RA on biological therapy?

Answer 4

• DAS28 score > 5.1 confirmed on 2 occasions (at least 1 month apart)
  AND
• undergone DMARD therapy with at least two including methotrexate, for six months.

Start with TNFa inhibitor plus methotrexate (if possible.)

Inadequate response to TNFa, in severe acute RA could try anti CD20 (rituximab)