RHEUMATOID ARTHRITIS Flashcards
RHEUMATOID ARTHRITIS OVERVIEW
-is an autoimmmune disese driven primarily by ACTIVATED T CELLS which give rise to cytokines
CLASSES OF DRUGS USED TO TREAT RA
1) NSAIDS: offer SYMPTOMATIC RELIEF, they reduce pain and inflammation
2) GLUCOCORTICOIDS:
–> ORAL corticoids relieve joint symptoms and control systemic manifestations, but their chronic use can cause many complications
_NOTE: BOTH NSAIDS AND GLUCOCORTICOIDS *DO NOT* PREVENT DISEASE PROGRESSION OR JOINT DESTRUCTION_
3) DMARDs: = Disease Modifying Anti-Rheumatic Drugs
- are a miscellaneous group of drugs with the potential to REDUCE/PREVENT JOINT DAMAGE
–> have no immediate analgesic effects, but can control symptoms and can DELAY/POSSIBLY STOP PROGRESSION OF THE DISEASE
-the effects of DMARDS may take 6 weeks - 6 months to become clinically evident
–> some biologics are effective within 2 weeks or less
METHOTREXATE
NON-BIOLOGIC DMARD
-generally the FIRST DMARD prescribed, is the FIRST CHOICE to treat RA
–> can be sued in mild, moderate, or severe RA
- doses of methotrexate required for RA are MUCH LOWER than those used in cancer chemotherapy
- adverse effects are minimized
BIOLOGIC DMARDS
are generally reserved for use in MODERATE-SEVERE DISEASE
LEFLUNOMIDE
NON-BIOLOGICAL DMARD
LEF-UNO-MIDE (left one of my) –> remember methotrexate… if it’s not working the guy in the car will say oh i left one of my…. –> BOOM –> it works
- seems to be AS effective as METHOTREXATE at reducing disease activity and progression
- patients who do not respond to methotrexate alone may benefit from COMBO THERAPY with leflunomide + methotrexate
HYDROXYCHLOROQUINE
NON-BIOLOGICAL DMARD
- remember this is the “Queen” of the drugs so it takes 3-6 months to work, and she often needs help, doesn’t work alone
- moderately effective for MILD RA
- usually well tolerated
- LEAST TOXIC of all DMARDs, and is the LEAST EFFECTIVE as monotherapy
- often used with other drugs, paricualry METHOTREXATE + SULFASALAZINE
- may require 3-6 months to show clinical benefits
SULFASALAZINE
NON-BIOLOGICAL DMARD
- is effective in RA
- beneficial effects typically require 2-3 months to become apparent
CYCLOSPORINE
NON-BIOLOGICAL DMARD
- can be helpful in some patients with RA
- NEPHROTOXICITY and many interactions with drugs and foods have limited its use
AZATHIOPRINE
NON-BIOLOGICAL DMARD
-used for patients with REFRACTORY RA
CYCLOPHOSPHAMIDE
NON-BIOLOGICAL DMARD
CycloPHOSPHAMIDE –> does whole thing!!!! (is not just a sporin, sporin is borin)
- is generally limited to the MOST SEVERE CASES of RA
- long-term use increases risk of infection and malignancy
ANTI-TNF DRUGS
BIOLOGICAL DMARD: ANTI-TNF
AEI (first 3 vowels) = 3 anti-tnf’s
1) ADALIMUMAB 2) INFLIXIMAB 3) ETANERCEPT
TNF-α effects are mediated by specific membrane-bound TNF receptors (TNFR1, TNFR2).
TNF-α is particularly important in the inflammatory process of rheumatoid arthritis.
TNF inhibitors act more quickly than nonbiologic DMARDs.
Use of TNF inhibitors in combination with methotrexate has synergistic beneficial effects.
RITUXIMAB
BIOLOGICAL DMARD
-commonly given concurrently with methotrexate or other non-biologic DMARDs
ABETACEPT
BIOLOGICAL DMARD
-effective in some patients who DID NOT RESPOND to non-biologic DMARDs or anti-TNF agents
–> is a BETA trial, might as well try it if other things aren’t working
ANAKINRA
BIOLOGICAL DMARD
- approved for moderate to severe RA
- is MODESTLY EFFECTIVE
GLUCOCORTICOIDS
- short courses of low-dose corticosteroids can be given for symptomatic relief until the beneficial effects of DMARDS become apparent
- intra-articular injection of a corticosteroid can often relieve an ACUTELY-INFLAMED RA joint with MINIMAL adverse effects
