Rheumatoid Arthitis

Question 1

Hydroxychloroquine SE and CI

Answer 1

Common SE:
- headache, stomach upset, dizziness
CI:
1) GDP6 deficiency
2) Vision changes

Question 2

Onset of oral RA drugs

Answer 2

All at least 1-3 months; Max effect 3-6 months

Question 3

Onset of Biologics

Answer 3

1-2 weeks but could take up to 3-4 months

Question 4

Leflunomide SE

Answer 4

Common:
1) diarrhea
2) increased BP
3) Teratogenicity for BOTH MALE and FEMALE (need to use chloestryamine for drug elimination b/c half life is up to 2 years)
Rarely
1) aplastic anemia (effects on bone marrow)
2) hepatotoxic

Question 5

Leflunomide CI and monitoring

Answer 5

1) hepatic or biliary disease
2) Viral hepatitis

Monitoring:

1) BP
2) CBC and platelets
3) liver enzymes
4) SrCr

Question 6

Sulfasalazine SE

Answer 6

Common:
1) Oral ulcers
2) Dye tears red
3) Stomach upset
4) Decreased sperm count
5) Rash
Rare: Myelosuppression (effects on bone marrow)

Question 7

Sulfasalazine CI

Answer 7

1) G6PD
2) sulfa allergy
3) GI obstruction

Question 8

Drugs only symptom relief and does not slow radiographic damage

Answer 8

1) Oral steroids
2) NSAID’s
3) Hydrochloroquine. (but it is a DMARD)

Question 9

Corner stone of treatment

Answer 9

MTX

• Can be used initially as monotherapy OR
• Initial combination with HCQ or SSZ in moderate to severe disease

Question 10

Role of leflunomide

Answer 10

-Can be used in place of MTX if have contraindications to MTX
- If MTX monotherapy is ineffective in patient, still keep it and add SSZ and HCQ b/c evidence this combo has high efficacy.
OR MTX combo with gold, azathioprine, cyclosporine, leflunomide.

Question 11

TNF alpha antagonists SE and CI

Answer 11

-could cause opportunistic infections and increased risk of lymphoma

Relative CI:

1) HF
2) Lupus
3) Demylineating disorders (i.e. MS)
4) latent TB.

Question 12

Infliximab CI and special usage

Answer 12

-Needs to be taken with MTX to avoid immune response to mouse portion of antibody

Contraindications - HF (> 5 mg/kg/infusion)and MS
Relative CI: lupus.

Question 13

What happens to RA in pregnancy

Answer 13

Most women symptoms improve

Question 14

Differences in 3 biologics

Answer 14

1) Route of admin: infliximab is IV while etanercept and adalimumab are SC
2) Dosing frequency: etanercept dosed once weekly maintanence dose while adalimumab dosed q2 wks. Infliximab dosed maintenance is q8 wks
3) Infliximab has to be taken with MTX