Rheumatoid Arthritis Flashcards
Prednisone counselling short term therapy
-insomnia take before 4pm
-stomach upset take w food
-monitor BP BG (inc both)
Prednisone side effects with long term therapy
-weight gain, moon face
-osteoporosis
-acne
-pancreatitis
-adrenal suppression
-increased risk of infection
-cataracts
-hyperglycemia
-hypertension
-muscle atrophy
-truncal obesity
-increased risk of MI
Arthrotec CI
Diclofenac/misoprostol
Abortifacient
csDMARDs include
methotrexate - gold standard
sulfasalazine - if MTX CI
hydroxychloroquine - mild disease
leflunomide - inc s/e
can csDMARDs be combined?
yes, tx can include MTX + adjunct sulfasalazine or hydroxychloroquine or leflunomide
which csDMARD treatment combination has the best evidence to support its use?
methotrexate, hydroxychloroquine and sulfasalazine (“triple therapy”) - superior in efficacy to methotrexate alone as initial therapy and similar to combination therapy
with methotrexate and a biologic
Improvement with csDMARDs may be
seen in ____ of therapy initiation and reach maximum effect in _____.
6–8 weeks
3–6 months
same for JAK inhibitors
Methotrexate dosing
dose: 20-25mg weekly with folic acid 5mg given 8-12h after (typically given the day after, or may also be daily)
Metoject IM but more commonly used SC in thigh or abdomen bc its less painful, safer, more effective than IM
Why give folic acid with Methotrexate?
reduces MTX toxicity - GI adverse effects, apthous ulcers, liver dysfunction
Methotrexate lab monitoring
baseline and monthly bloodwork (should be done 1-2 days just prior to the weekly MTX dose)
Methotrexate AE & DDI
side effects: Nausea/vomiting, diarrhea, mouth ulcers, flu-like aches, headache, pneumonitis (rare), sun sensitivity, hepatotoxicity
(elevated LFTs)
DDI: smoking may reduce efficacy, avoid alcohol at least within 24h of dose
Hydroxychloroquine administration
take w food or at bedtime to minimize flatulence
Hydroxychloroquine AE, DDI, monitoring
monitoring: eye exam at baseline then annually after 5 years for retinopathy
unique DDI: smoking may reduce efficacy
side effects: Nausea, abdominal cramping, diarrhea, flatulence, headache, skin rash, sun sensitivity, corneal and retinal deposition
with long term use at high dose
Sulfasalazine administration
take with food
Sulfasalazine AE
side effects: Dose related GI intolerance and headache. Hypersensitivity and sun sensitivity reactions (with or without fever),
diarrhea, can discolour urine (orange), oligospermia (reversible), bone marrow toxicity (rare), may affect fertility in men.