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7118 - Clinical Therapeutics for Core Conditions > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

What is rheumatoid Arthritis?

A

It is a systemic disease and it causes joint inflammation.
Antibodies can be measured to aid diagnosis. These can precede inflammation and can be measured years before a patient gets any symptoms.

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2
Q

List three symptom manifestations of RA

A
  • lung disease
  • vasculitis
  • rheumatoid nodules
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3
Q

Main treatments for RA in both early and later stages of RA

A

DMARDS
steroids
NSAIDS

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4
Q

Treat
Assess
Target

What does this mean?

A
  • Aim for clinical remission or low disease activity
  • regularly assess disease activity using validated composite measures of disease activity that include joint assessments such as DAS28 - this can be 3 or 6 monthly
  • adjust tight control of treatment until the target is reached
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5
Q

what are the main DMARD treatments?

A
  • methotrexate
  • hydroxychloriquine
  • sulfasalazine

luflonamide can be used if others are not tolerated

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6
Q

How long does it take for DMARDS to have an effect and how long does it take for them to have the full effect?

A
  • four to six weeks to see an effect

- four to six months to have a full response

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7
Q

What is the recommended treatment for RA

A

a combination of DMARDS plus steroids.

Trials have shown that a combination of DMARDS do not produce any more adverse effects than a single DMARD and it achieves better control of the disease

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8
Q

What is the gold standard DMARD to use in RA?

A

methotrexate

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9
Q

What pre-screening to people need to have before using methotrexate?

A

chest X-ray, FBC, U&E’s, LFTS. This allows us to repeat and easily identify toxicity.

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10
Q

What time scale do we give for a DMARD to work before switching to another?

A

6 months

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11
Q

Why is folic acid prescribed along side methotrexate?

A

to decrease side effects such as mouth ulcers, stomatitis, gastrointestinal and liver toxicity.

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12
Q

What test should be taken before prescribing azathioprine

A

TPMT. Thiopurine Methyltransferase.

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13
Q

What baselines should be taken before commencing hydroxychloroquine.

A

ophthalmic examination

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14
Q

Can women get pregnant or breastfeed when taking D-mards?

A

No

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15
Q

What baselines should be taken prior to commencing a DMARD?

A

height, weight, eGFR, chest X-ray, fBC, ALT/AST/albumin

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16
Q

What vaccines should pt get who are on a DMARD?

A

flu vaccine

17
Q

When should DMARDS be used in extreme caution?

A

liver cirrhosis

18
Q

When is a patient eligible for Biologic?

A

When they have tried at least TWO DMARDS, one has to be methotrexate.

19
Q

What score is used to see if a patient is eligible for biologic and what does the score look at?

A

DAS 28

  • It is based on the number of swollen and tender joints
  • patients assessment of their condition using a visual analogue scare out of 100
  • measurement of CRP

The score is based on assessing 28 joints including the hands, wrists, elbows and shoulders,

TWO DAS score of more than 5.1 approximately one month apart makes a patient eligible for biologic.

20
Q

What DAS28 score does a patient need to have to make them eligible for a biologic?

A

a score of 5.1 on two occasions approximately 1 month apart

21
Q

Patient require pre-screening before starting a biologic of

A 
TB
hep-B
HIV
infection
counsel on pregnancy
22
Q

What improvement in DAS28 score do we need to see before agreeing to continue treatment?

A

An improvement of 1.2 or more after 6 months of treatment.

If that has not occurred then we should discontinue treatment

23
Q

CRP, WCC and neutrophils are often raised in RA? True or false?

A

True

24
Q

RA is more common in females than males? True or false

A

True

25
Q

There is a link between smoking and RA? True or false?

A

True

26
Q

If eGFR goes <50ml/min should methotrexate be discontinued?

A

No

Can reduce dose

Avoid in severe impairment

27
Q

Haematological side effects are seen in the first 3 months of treatment? True or False?

A

True

28
Q

What do we use for the washout period of leflunomide

A

Colestyramine 8g three times a day for 11/7

29
Q

Does rituximab has the highest incidence of side effects reported for biological treatments?

A

Yes

30
Q

What drug doe we use for RA in patients with concomitant HF?

A

Abatercept

31
Q

Should NSAIDS be avoided in RA when patients are taking methotrexate?

A

No

32
Q

How long does anti inflammatory effect happen with NSAIDs?

A

3 weeks

33
Q

How long does it take for a DMARD to stabilise ?

A

6 months

34
Q

Conception

A

Avoid during and at least 6 months after in both men and women

35
Q

If a Dmard does not lead to objective benefit within 6 months do we discontinue?

A

No - review and increase dos eor add in another agent

7118 - Clinical Therapeutics for Core Conditions (31 decks)

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