Rheumatoid Arthritis Flashcards
Who is affected by most by rheumatoid arthritis, risk factors
Women between 50 and 75/ smoking, genetics, presence of autoantibodies
What is Rheumatoid arthritis
autoimmune disease that causes inflammation that can lead to bone surface erosions
Clinical presentation of rheumatoid arthritis
symmeterical joint swelling (synovitis). morning stiffness lasting more than one hour
What should be monitored when giving therapy for Rheumatoid arthritis
acute phase reactants ( C-reactive protien and erythrocyte sedimentation rate)
What are goals of treatment for rheumatoid arthritis
control disease activity, alleviate pain, maximize quality of rate, induce complete remission
What is the best way evaluate the disease activity of rheumatoid arthritis
DAS/DAS28 (ESR or CRP, patient global assessment)
What non-pharmacologic therapy for rheumatoid arthritis
rest, physical therapy, achieve ideal body weight, stop smoking
What is an important Non-Disease-Modifying therapy for Rheumatoid arthritis, benefits
Corticosteroids, controls symptoms quickly, used in flares, can be used intraarticularly
What is the biggest complication with using corticosteroids
Long term adverse affects
T/F: All vaccines should be avoided when patients are on DMARDs
False: Live attenuated vaccines should be avoided while on biologic DMARDs
What are the non-biologic DMARDs
Methotrexate, Sulfasalazine, Hydroxychloroquine, Leflunomide
What drug is the cornerstone of rheumatoid arthritis therapy, what is the MOA
methotrexate, dihydrofolate reductase inhibitor while also inhibiting production of IL-1
What is the biggest adverse effect of methotrexate
hepatotoxicity
What is the dosing for methotrexate
10-25 mg per week (as 2.5 mg tablets)
What is the drug that can be used as an alternative to methotrexate, MOA
Leflunomide, inhibits dihydroorotate dehydrogenase
What non-biologic DMARD is often used in combination, what is a possible drug interaction
Sulfasalzine, warfarin
What are common adverse effects, what side effect could lead to a larger problem
Nausea, vomitting and diarrhea/ Rash
Which of the non biological DMARDs is an antimalarial, MOA
Hydroxychloroquine, interferes with antigen processing in APCs
What drug is a severe adverse effects of hydroxchloroquine
Ocular toxicity and retinopathy
T/F: Ocular toxicity caused by hydroxychloroquine is reversible through reducing use of medication while the retinopathy is irreversible
True
What are the risk factors of hydroxychloroquine causing retinopathy
Daily dose greater than 5mg/kg, duration of use after 5 years
How should retinopathy be monitored when using hydroxychloroquine
Eye exam within the first year and every year
When should DMARD therapy be modified
repetitive flares, unacceptable disease activity, progressive joint damage
What are biologic DMARDs
Etanercept, Infliximab, Adalimumab, Certolizumab, Golimumab
What are the basics of biologic DMARDs
administered parenterally, work quickly, potential for serious side effects
Which biological DMARDS work on the T-cell receptor resulting in down regulation of T cells, which work on CD20 of B cells, which are IL-6 receptor inhibitors
Abtacept, Rituximab, Tocilizumab and Sarilumab
When would biologic DMARDS used
used for moderate to severe rheumatoid arthritis , often used in patients who fail MTX, can be added as a steroid sparing agent
T/F: It is fine to combine more than one Biologic DMARD
False: Do not combine more than one biologic DMARDS due to overlapping side effects
What is the first line biologic DMARD for rheumatiod arthritis
Anti-TNF agents
T/F: If one biological DMARD from its class is not working it is reasonable to use a 2nd biological DMARD from the same class as long as it’s not at the same time
True
What must be monitored when using Anti-TNF agents
TB skin or blood test, Hep B reactivation, histoplasmosis, malignancy
What is the MOA of abatacept, what patients should avoid this medication
binds B7 using the extracellular domain of CTLA-4 therefore down regulating T cells, patients with COPD and/or smoke
T/F: There is no evidence of increased incidence of TB in patients and no evidence of increased incidence of cancer when taking rituximab
True
What are the ADRs for rituximab
infusion reaction, reaction of Hep B, Stevens-Johnson, PML caused by JC virus
What must be monitored before using Tocilizumab and Sarilumab
Do not start if ANC is less than 2000, PLT is less than 100,000 (tocilizumab) or 150,000 (Sarilumab)
What are adverse efffects of Tocilizumab and Sarilumab
GI perforation and dyslipidemia
What are the JAK Kinase inhibitors, how are they taken
Tofacitinib and baricitinib, by mouth
T/F: Janus Kinase inhibitors can be combined with a biologic and potent immunosuppresive drugs for peak efficacy
False: Do not combine Jak/Stat inhibitors with biologics and avoid in patients who are taking tacrolimus, cyclosporine, and azathioprine
Which Jak/Stat inhibitor goes through extensive liver metabolism and may be effected by CYP induces or inhibitors
Toacitinib
Which Jak/Stat inhibitor is not recommended due to the CrCl less than 60
Baricitinib
What are the ADRs of Janus Kinase inhibitors
Thrombosis (baricitinib), GI perforation, lipid changes
