RA + its drugs- 4th year Flashcards
1st line management of RA
DMARD monotherapy +/- short course of bridging prednisolone
2nd line RA management
DMARD combination therapy
no response to atleast 2 DMARDs including methotrexate management RA?
Biologics
Give examples of DMARDS
-Methotrexate
-Sulfalazine
-Leflunomide
-Hydroxychloroquine
mildest DMARD + what is it often used for?
-Hydroxychloroquine
mild RA + palindromic rheumatism (inflammatory arthritis that only lasts a few days)
side effects of methotrexate + what monitoring needs done?
-myelosupression
-liver cirrhosis
-pneumonitis
need to monitor FBC + LFTs
what biologics are commonly used in RA?
-TNF inhibitors
-Rituximab
Give examples of TNF inhibitors
Infliximab- monoclonal antibody
adalimumab- monoclonal antibody
Etanercept- recombinant human protein
what is rituximab
anti- CD 20 monoclonal antibody
type of biologic
SE of biologics?
-immunosuppression
-increased risk of non melanoma skin cancer
-reactivation of latent TB
what med should be taken alongside methotrexate?
folic acid 5mg once a week
SE sulfasalazine (DMARD)
-Orange urine
-Male infertility (reduced sperm count)
SE hydroxychloroquine (DMARD)
-Retinal toxicity
-Blue- grey skin pigmentation
-Hair bleaching
SE leflunomide (DMARD)
-Hypertension
-Peripheral neuropathy
SE rituximab (biologic)
night sweat + thrombocytopenia (low platelet)
what score allows RA to be monitored?
DAS 28
-Disease activity score 28
how is RA diagnosed?
Based on clinical findings and blood results
Blood results:
-Increased inflammatory markers (ESR + CRP)
-Anti CCP antibody (90%)
-RF (70%)
what is seeen on Xray of RA?
-periarticular osteopenia
-boney erosions
-soft tissue swelling
-joint destruction and deformity
what signs may be seen in hands of someone with RA?
-Z shaped deformity in thumb
-ulnar deviation of MCP
-Swan neck deformity (hyperextended PIP + flexed DIP)
-Boutonniere deformity (flexed PIP + hyperextended DIP)
what pattern does RA present in the joints?
symmetrical polyarthritis most commonly affects:
-MCP
-PIP
-Wrist
-MTP
does it get worse or improve with activty?
improves with activity, worse at rest
how long morning stiffness with RA?
> 30 mins
eye manifestations of RA?
-Dry eye syndrome (keratoconjunctivitis sicca)
-Episcleritis
-Scleritis
-Keratitis
what is Felty’s syndrome?
severe + rare disease presenting as RA, neutropenia + splenomegaly
is severe RA in back, what ma occur?
Atlantoaxial subluxation
- Synovitis + damage to the ligaments around the odontoid peg of the axis (C2) allow it to shift within atlas (C1)
-Can cause spinal cord compression + is emergency
gene linked to RA?
HLA DR4
who is increased risk of RA?
W>M
Smokers
Obesity
what is palindromic rheumatism?
-self limiting episodes of inflammatory arthritis, with pain, stiffness + swelling, typically only affecting a few joints
-symptoms typically last days and then completely resolves
-treat with hydroxychloroquine if needed
