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PHM702 > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

RA - Prodromal Symptoms

A

fatigue, weakness
fever
weight loss
decreased mood
myalgias

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2
Q

RA - Signs

A

symmetric swelling of hands / wrists / ankles / feet
synovitis, erythematous, warm
rheumatoid nodules present
grip weakness, muscle atrophy

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3
Q

RA - Symptoms

A

occur with use and rest
joint pain and stiffness last > 6 wks
decreased range of motion
joint deformity

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4
Q

RA - Complications

A

hematologic involvement
pulmonary involvement
cardiac involvement
ocular involvement
amyloidosis
vasculitis
osteoporosis

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5
Q

RA - Diagnosis

A

elevated ESR, CRP
elevated rheumatoid factor
elevated ANAs, ACPAs

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6
Q

RA - Goals of Therapy

A

decrease pain, maintain joint mobility, maintain ADLs
slow destructive joint changes
achieve low disease activity

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7
Q

RA - Conventional Synthetic DMARDs

A

methotrexate
leflunomide
hydroxychloroquine
sulfasalazine

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8
Q

RA - Biologic TNF Inhibitors

A

etanercept
infliximab
adalimumab
golimumab
certolizumab

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9
Q

RA - Biologic Non-TNF Inhibitors

A

abatacept
rituximab
tocilizumab
anakinra
sarilumab

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10
Q

RA - Targeted Synthetic DMARDs

A

JAK inhibitors (tofacitinib, baricitinib, upadacitinib)

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11
Q

Methotrexate - Adverse Reactions

A

stomatitis
dyspepsia
immunosuppression

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12
Q

Methotrexate - Boxed Warnings

A

GI toxicity
dermatological reactions
pulmonary fibrosis
myelosuppression
increased LFTs

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13
Q

Methotrexate - CIs

A

pregnancy & breastfeeding
renal & liver disease
immunodeficiency
myelosuppression

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14
Q

RA - Methotrexate’s Place in Therapy

A

first-line treatment, csDMARD of choice
except DMARD-naive with low disease activity

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15
Q

Leflunomide - Boxed Warnings

A

embryofetal toxicity
hepatotoxicity

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16
Q

Leflunomide - Adverse Reactions

A

NVD
alopecia
rash (SJS / TEN potential)
peripheral neuropathy
hypertension

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17
Q

Leflunomide - DDIs

A

warfarin (decreases INR)
inhibits OAT3 and OATP1B1/3

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18
Q

Leflunomide - Drug Elimination

A

with the help of cholestyramine

19
Q

Sulfasalazine - Adverse Reactions

A

NV, abdominal pain
weight loss
headache
oligospermia
rash, pruritis, urticaria
hemolytic anemia

20
Q

Sulfasalazine - CIs

A

intestinal or urinary obstruction
porphyria
sulfa allergy

21
Q

Hydroxychloroquine - Adverse Reactions

A

NVD
irreversible retinal damage
QT prolongation
dermatological reactions

22
Q

Hydroxychloroquine - Monitoring

A

ophthalmologic exam at baseline and every 3 months

23
Q

Methotrexate - Monitoring

A

rule out pregnancy and check X-ray at baseline

24
Q

Leflunomide - Monitoring

A

rule out pregnancy at baseline

25
Q

Sulfasalazine - Monitoring

A

rule out G6PD deficiency at baseline

26
Q

csDMARD - Monitoring

A

CBC
LFTs
SCr

27
Q

DMARD-naive Recommendations - Moderate-to-High Disease Activity

A

csDMARD monotherapy
methotrexate recommended first line

28
Q

DMARD-naive Recommendations - Low Disease Activity

A

csDMARD monotherapy
hydroxychloroquine recommended first line

29
Q

RA - Biologic Therapy Indications

A

moderate-high disease activity despite csDMARD monotherapy
intolerance / CI to csDMARD
use in combination with MTX

30
Q

RA - DMARD Recommendations at Target

A

continue regimen (do not reduce dose)
continue at least 1 DMARD
must be at target for 6 months before considering dose reduction

31
Q

RA - DMARD Recommendation NOT at Target

A

try MTX if haven’t tried before
switch to SQ MTX if used PO before
add another csDMARD
add bDMARD or tsDMARD

32
Q

TNF Inhibitors - Adverse Reactions

A

infections
injection site reactions
URTIs
rash

33
Q

TNF Inhibitors - BBWs

A

malignancy
serious infections (TB, sepsis, fungal, opportunistic)

34
Q

Rituximab - Monitoring

A

CBC with each dose

35
Q

Biologic DMARDs - Monitoring

A

latent TB at baseline and throughout treatment

36
Q

JAK Inhibitors - BBWs

A

opportunistic infections
malignancies
thrombosis

37
Q

JAK Inhibitors - Adverse Reactions

A

increased HDL / LDL
headache
URTI
infections

38
Q

RA - Drugs to Avoid in Pregnancy

A

methotrexate
leflunomide

39
Q

RA - Drugs to Use in TB

A

JAK inhibitor or biologic after 1 month of TB treatment

40
Q

RA - Drugs to Use in HF

A

non-TNF inhibitor or JAK inhibitor

41
Q

RA - Drugs to Use in Lymphoproliferative Disorder

A

rituximab

42
Q

RA - Drugs to Avoid in Liver Disease

A

methotrexate
leflunomide

43
Q

RA - Vaccines Before Treatment Initiation

A

pneumococcal
influenza
hepatitis B
HPV
live Herpes Zoster

PHM702 (20 decks)

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