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Autacoids > Rheumatoid arthritis > Flashcards

Rheumatoid arthritis Flashcards

1
Q

most commonly affected joints in RA

A

metacarpopharyngeal joint
intercarpopharyngeal joint

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2
Q

Acute arthritis - symptomatic treatment

A

doc is anti inflammatory drugs ( NSAIDs except Paracetamol)
nephrotoxic

if resistent - corticosteroid (intrarticular inj) - Prednisolone, Triamcinolone
adv- renal safe

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3
Q

Definitive treatment of RA

A

retard joint destruction
DOC- DMARD’s (disease modifying antirheumatic drugs) or SAARD’s (slowly acting anti rheumatic drugs)

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4
Q

Conventional DMARD’S

A

Methotrexate
Sulfasalazine
Penicillamine
Azathioprine and miscellaneous
Gold
Leflunomids (100mg)
Chloroquine/hydroxy chloroquine

(Mallika Sherawat PAGAL C)

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5
Q

DOC for RA

A

Methotrexate

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6
Q

Management

A

mild RA- hydroxy chloroquine+ sulfasalazine

severe RA/no response - Methotrexate

still no response - add other drugs to Methotrexate

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7
Q

DOC for RA in pregnancy

A

NSAIDS
avoid DMARD’S in pregnancy
but if you have to give, safest - hydroxy chloroquine

Methotrexate is contraindicated

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8
Q

Biologics DMARD’S with target anti TNF alpha

A

Infliximab - iv (doc for Methotrexate resistant rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis & azathioprine resistant ulcerative colitis and Crohn’s disease) SE: reactivation of latent TB

Certolizumab -sc
Adalimumab -sc
Golimumab - sc
Eternecept - sc (decoy receptor)

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9
Q

Biologics DMARD’S with target anti IL6

A

Tolicizumab (methotrexate resistant rheumatoid arthritis and treatment of cytokines storm in COVID 19

Sarilumab

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10
Q

Biologics DMARD’S with target anti CD20

A

Rituximab

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11
Q

Biologics DMARD’S with target anti IL1

A

Anakinra

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12
Q

Biologics DMARD’S with target recombinant CTLA4

A

Abatacept

new: Belatacept: organ transplantation

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13
Q

JAK inhibitor

A

JAK is receptor for inflammatory mediators like IL

JAK 1,3- Tofacitinib - RA, IBD SE- bone marrow suppression
JAK 1,2- Baricitinib
JAK 1 - Upadacitinib

given orally
(rest DMARD’S are all injection)

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14
Q

Methotrexate

A

immunosuppressive action

antifolate - inhibitor of DHFR enzyme
increase adenosine efflux by inhibiting adenosine deaminase (adenosine kills lymphocytes)

Methotrexate low dose in RA (30-70 mg)week)
Methotrexate high dose in cancers (100mg/day)

Doc for RA, ankylosing spondylitis, psoriatic arthritis, erythrodermic psoriasis

SE- megaloblastic anemia, hepatotoxic, pneumonia or lung damage

Monitor CBC, LFT, chest x-ray

contraindicated in lactation and pregnancy (category X) - neural tube defects

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15
Q

Sulfasalazine

A

Prodrug
1. Sulfapyridine attached to
2. 5 amino salicylic acid

attached by azo bond

azon bond broken down by colonic bacteria

sulfapyridine gets absorbed in blood, goes to synovial joints and shows immunosuppressive action in RA
SE: decrease sperm count, causes sulfa allergy

5ASA acts locally for the treatment of ulcerative colitis

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16
Q

5ASA only drug for treatment of ulcerative colitis

A

Mesalazine
Olsalazine
Basalazide

17
Q

Penicillamine
Gold

A

old drug
rarely used

gold - Aurofin, Aurothiomalate

SE:
nephrotoxic - most dangerous
dermatitis - most common
diarrhoea - 2nd most common
DLE (drug induced SLE)

18
Q

RA. + other systemic involvement

A

Azathioprine
Cyclosporin
Tacrolimus

19
Q

Leflunomide

A

dose-100mg

inhibitors of DHOD (inhibits pyrimide synthesis)
antifolate

SE- megaloblastic anemia, hepatotoxic

contraindicated in pregnancy

Leflunomide (prodrug) - treatment of RA
Active form- Teriflunomide - treatment of multiple sclerosis

20
Q

Chloroquine/ hydroxy chloroquine (more preferred in RA)

A

Chloroquine:
immunosuppressive - reduces IL1, IL6, TNF alpha
highest volume of distribution - deposits in all organs- bull’s eye retinopathy (permanent blindness) , QT prolongation

Hydroxy chloroquine

more water soluble, less volume distribution, longer and better immunosuppressant

21
Q

Methotrexate resistant cases

A

rheumatoid arthritis
psoriatic arthritis
ankylosing spondylitis

Infliximab is DOC

22
Q

DOC for azathioprine resistant ulcerative colitis and Crohn’s disease

A

Infliximab

23
Q

latent TB test

A

Montoux test or PPD (purified protein derivative) test

Autacoids (4 decks)

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