Rheumatoid Arthritis

Question 1

Gold Salts

Answer 1

Class: DMARD
Mechanism: Antipruritic; represses immune responsiveness (inhibits functional capabilities of macrophages)
Therapeutics: Rheumatoid arthritis
Side Effects: Serious side effects in 30% of pts

Question 2

Quinolones

Answer 2

Class: DMARD (antimalarial)
Mechanism: Reduces T-cell activation & chemotaxis
Therapeutics: Rheumatoid arthritis, SLE
Side Effects: Retinal damage (chloroquine)

Question 3

“Glucocorticoids

(Corticosteroids)”

Answer 3

Class: DMARD
Mechanism: “1. Inhibits phospholipase A2 (inhibiting release of arachidonic acid and, thus, formation of prostaglandins)
2. Inhibits cytokine production (which prevents induction of COX-2)”
Therapeutics: Rheumatoid arthritis; acute gouty arthritis (intraarticular injection for relief of acute monoarticular gout)
Side Effects: Cushingoid symptoms

Question 4

Sulfasalazine (Azulfidine)

Answer 4

Class: DMARD
Mechanism: Likely inhibition of IL-1 & TNF-alpha release
Therapeutics: Rheumatoid arthritis
Side Effects: N/V, skin rashes, neutropenia (30% of patient discontinue drug)

Question 5

Methotrexate (Trexall)

Answer 5

Class: “DMARD
(Immunosuppressive)”
Mechanism: “1. Inhibition of aminoimidazolecarboxamide (AICAR) transformylase and
thymidylate synthetase, with secondary effects on PMN chemotaxis
2. Causes adenosine accumulation, which inhibits inflammation”
Therapeutics: Rheumatoid arthritis
Side Effects: Nausea, stomatitis, hepatotoxicity (rare)

Question 6

Leflunomide (Arava)

Answer 6

Class: "DMARD
(Immunosuppressive)"
Mechanism: Inhibits dihydroorotate dehydrogenase (DHODH), which inhibits T-lymphocyte response to stimuli
Therapeutics: Rheumatoid arthritis
Side Effects: Diarrhea, hepatotoxity

Question 7

Etanercept (Enbrel)

Answer 7

Class: Biologic Response Modifiers
Mechanism: Blocks binding of TNF to TNF receptors
Therapeutics: Rheumatoid arthritis

Question 8

Infliximab (Remicade)

Answer 8

Class: Biologic Response Modifiers
Mechanism: Blocks binding of TNF to TNF receptors
Therapeutics: Rheumatoid arthritis
Side Effects: Antigenic response to murine monoclonal Ab

Question 9

Adalimumab (Humira)

Answer 9

Class: Biologic Response Modifiers
Mechanism: Blocks binding of TNF to TNF receptors
Therapeutics: Rheumatoid arthritis

Question 10

Golimumab

Answer 10

Class: Biologic Response Modifiers
Mechanism: Blocks binding of TNF to TNF receptors
Therapeutics: Rheumatoid arthritis
Side Effects: Risk of serious infections

Question 11

Certolizumab

Answer 11

Class: Biologic Response Modifiers
Mechanism: Blocks binding of TNF to TNF receptors
Therapeutics: Rheumatoid arthritis
Side Effects: Risk of serious infections

Question 12

Anakinra (Kineret)

Answer 12

Class: Biologic Response Modifiers
Mechanism: IL-1 Receptor Antagonist
Therapeutics:Rheumatoid arthritis
:

Question 13

Tocilizumab (Actemra)

Answer 13

Class: Biologic Response Modifiers
Mechanism: IL-6 Receptor Antagonist
Therapeutics: Rheumatoid arthritis

Question 14

Rituximab (Rituxan)

Answer 14

Class: Biologic Response Modifiers
Mechanism: Anti-CD20 mAb, reduces circulating B cells
Therapeutics: Rheumatoid arthritis
Side Effects: Infections; hypersensitivity reactions

Question 15

Abatacept (Orencia)

Answer 15

Class: Biologic Response Modifiers
Mechanism: Inhibits T-cell activation and induces T-cell apoptosis
Therapeutics: Rheumatoid arthritis
Side Effects: Headaches; infections