RA: Therapeutics Flashcards
RA = Rheumatoid arthritis
What are the 4 main types of treatments of inflammatory arthritis?
- Medicines
- Injections
- Therapies
- Surgery
What are the categories of therapeutics used in RA?
- Non-steroidal anti inflammatories (NSAIDS)
- Disease modifying anti rheumatic drugs (DMARD)
- Biologics
- Corticosteroids
Definition of DMARD: (this may or may not be useful)
What is the most commonly used DMARD?
A group of structurally unrelated, typically small molecule drugs which have been demonstrated to have slow onset effect on disease activity and retard disease progression. Traditionally, these have been associated with identifiable toxicity profiles and risk of occasional serious adverse event.
- Methotrexate [cheap, effective and well tolerated]
- Sulfasalazine
What is the management approach for RA?
- Early and aggressive intervention key to most successful outcomes
- Effective suppression of inflammation will improve symptoms and prevent joint damage and disability
Name the main drug routine strategies:
Sequential monotherapy
Combination: step up, step down and parallel
Treat to target
How do biologics work in relation to RA?
- Target key aspects of inflammatory cascade
- The biologic dmards are typically large complex proteins that need to be given parentally
- Compared to normal DMARD: work faster, more expensive and do have higher toxicities
Name some of the main biologics.
- TNFalpha inhibitors
- IL-1 inhibitors
- Anti B cell therapies
- Anti T cell therapies
What are the issues with biologics?
- Enhanced response when co prescribed with Mtx
- Toxicity: Minor/Infection/malignancy
- Cost: £9500 vs £5
Explain the use of corticosteroids in RA:
- Corticosteroids can be prescribed by mouth, by i-a or i-m injection and by i-v infusion
- Short term benefit v long term toxicity
- Rarely appropriate as single drug therapy
