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504 (Immunology) > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

Who is affected by most by rheumatoid arthritis, risk factors

A

Women between 50 and 75/ smoking, genetics, presence of autoantibodies

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2
Q

What is Rheumatoid arthritis

A

autoimmune disease that causes inflammation that can lead to bone surface erosions

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3
Q

Clinical presentation of rheumatoid arthritis

A

symmeterical joint swelling (synovitis). morning stiffness lasting more than one hour

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4
Q

What should be monitored when giving therapy for Rheumatoid arthritis

A

acute phase reactants ( C-reactive protien and erythrocyte sedimentation rate)

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5
Q

What are goals of treatment for rheumatoid arthritis

A

control disease activity, alleviate pain, maximize quality of rate, induce complete remission

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6
Q

What is the best way evaluate the disease activity of rheumatoid arthritis

A

DAS/DAS28 (ESR or CRP, patient global assessment)

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7
Q

What non-pharmacologic therapy for rheumatoid arthritis

A

rest, physical therapy, achieve ideal body weight, stop smoking

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8
Q

What is an important Non-Disease-Modifying therapy for Rheumatoid arthritis, benefits

A

Corticosteroids, controls symptoms quickly, used in flares, can be used intraarticularly

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9
Q

What is the biggest complication with using corticosteroids

A

Long term adverse affects

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10
Q

T/F: All vaccines should be avoided when patients are on DMARDs

A

False: Live attenuated vaccines should be avoided while on biologic DMARDs

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11
Q

What are the non-biologic DMARDs

A

Methotrexate, Sulfasalazine, Hydroxychloroquine, Leflunomide

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12
Q

What drug is the cornerstone of rheumatoid arthritis therapy, what is the MOA

A

methotrexate, dihydrofolate reductase inhibitor while also inhibiting production of IL-1

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13
Q

What is the biggest adverse effect of methotrexate

A

hepatotoxicity

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14
Q

What is the dosing for methotrexate

A

10-25 mg per week (as 2.5 mg tablets)

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15
Q

What is the drug that can be used as an alternative to methotrexate, MOA

A

Leflunomide, inhibits dihydroorotate dehydrogenase

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16
Q

What non-biologic DMARD is often used in combination, what is a possible drug interaction

A

Sulfasalzine, warfarin

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17
Q

What are common adverse effects, what side effect could lead to a larger problem

A

Nausea, vomitting and diarrhea/ Rash

18
Q

Which of the non biological DMARDs is an antimalarial, MOA

A

Hydroxychloroquine, interferes with antigen processing in APCs

19
Q

What drug is a severe adverse effects of hydroxchloroquine

A

Ocular toxicity and retinopathy

20
Q

T/F: Ocular toxicity caused by hydroxychloroquine is reversible through reducing use of medication while the retinopathy is irreversible

A

True

21
Q

What are the risk factors of hydroxychloroquine causing retinopathy

A

Daily dose greater than 5mg/kg, duration of use after 5 years

22
Q

How should retinopathy be monitored when using hydroxychloroquine

A

Eye exam within the first year and every year

23
Q

When should DMARD therapy be modified

A

repetitive flares, unacceptable disease activity, progressive joint damage

24
Q

What are biologic DMARDs

A

Etanercept, Infliximab, Adalimumab, Certolizumab, Golimumab

25
Q

What are the basics of biologic DMARDs

A

administered parenterally, work quickly, potential for serious side effects

26
Q

Which biological DMARDS work on the T-cell receptor resulting in down regulation of T cells, which work on CD20 of B cells, which are IL-6 receptor inhibitors

A

Abtacept, Rituximab, Tocilizumab and Sarilumab

27
Q

When would biologic DMARDS used

A

used for moderate to severe rheumatoid arthritis , often used in patients who fail MTX, can be added as a steroid sparing agent

28
Q

T/F: It is fine to combine more than one Biologic DMARD

A

False: Do not combine more than one biologic DMARDS due to overlapping side effects

29
Q

What is the first line biologic DMARD for rheumatiod arthritis

A

Anti-TNF agents

30
Q

T/F: If one biological DMARD from its class is not working it is reasonable to use a 2nd biological DMARD from the same class as long as it’s not at the same time

A

True

31
Q

What must be monitored when using Anti-TNF agents

A

TB skin or blood test, Hep B reactivation, histoplasmosis, malignancy

32
Q

What is the MOA of abatacept, what patients should avoid this medication

A

binds B7 using the extracellular domain of CTLA-4 therefore down regulating T cells, patients with COPD and/or smoke

33
Q

T/F: There is no evidence of increased incidence of TB in patients and no evidence of increased incidence of cancer when taking rituximab

A

True

34
Q

What are the ADRs for rituximab

A

infusion reaction, reaction of Hep B, Stevens-Johnson, PML caused by JC virus

35
Q

What must be monitored before using Tocilizumab and Sarilumab

A

Do not start if ANC is less than 2000, PLT is less than 100,000 (tocilizumab) or 150,000 (Sarilumab)

36
Q

What are adverse efffects of Tocilizumab and Sarilumab

A

GI perforation and dyslipidemia

37
Q

What are the JAK Kinase inhibitors, how are they taken

A

Tofacitinib and baricitinib, by mouth

38
Q

T/F: Janus Kinase inhibitors can be combined with a biologic and potent immunosuppresive drugs for peak efficacy

A

False: Do not combine Jak/Stat inhibitors with biologics and avoid in patients who are taking tacrolimus, cyclosporine, and azathioprine

39
Q

Which Jak/Stat inhibitor goes through extensive liver metabolism and may be effected by CYP induces or inhibitors

A

Toacitinib

40
Q

Which Jak/Stat inhibitor is not recommended due to the CrCl less than 60

A

Baricitinib

41
Q

What are the ADRs of Janus Kinase inhibitors

A

Thrombosis (baricitinib), GI perforation, lipid changes

504 (Immunology) (19 decks)

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