rheumatoid arthritis

Question 1

what type of disorder is rheumatoid arthritis

Answer 1

it is a Chronic systemic inflammatory auto-immune disorder

Question 2

what are some symptoms of rheumatoid arthritis

Answer 2

Joint inflammation, synovial proliferation, destruction of articular cartilage

Question 3

what is the pathogenesis of rheumatoid arthritis

Answer 3

immune complexes activate complement which in turn releases cytokines. the cytokines release one of the two

1. TNF-a, IL-1
2. prostaglandins

Question 4

what would DMARDs (disease modifying anti-rheumatic drugs) do to a patient suffering with rheumatoid arthritis

Answer 4

To inhibit / halt the underlying immune process /prevent the long-term damage (articular cartilage damage, bone erosions)

Question 5

what are some side effects of taking methrotrexate

Answer 5

Oral ulcerations, Nodulosis, nausea, GI upset, cytopenias, liver damage, chest infection

Question 6

how does cyclosporine treat RA

Answer 6

inhibits IL-1 and IL-2 receptor production. Its major adverse effect is nephrotoxicity, which gets attenuated with NSAIDs, enzyme inhibitors.
NOTE ( NOT IN USE CURRENTLY)

Question 7

why is azathioprine not used frequently in the medical field

Answer 7

Use in RA is declined due to toxicity (BM depression, leukopenia, thrombocytopenia, alopecia, increased risk of infections etc)

Question 8

what is the advantage of using hydroxychloroquine instead of other DMARDS

Answer 8

has less effects on the liver and immune system than other DMARDs

Question 9

what are some mechanisms of action of leflunomide

Answer 9

It reduces DNA / RNA synthesis, hence lymphocyte proliferation

Antibody production by B-cells may be depressed.

Question 10

what are some side effects of leflunomide

Answer 10

diarrhoea, headache, rashes, loss of hair, thrombocytopenia, liver damage, increased chances of chest infections

Question 11

what is the mechanism of action of sulfasalazine

Answer 11

Sulfapyridine- active moiety, suppress the generation of superoxide free radicals and cytokine release by inflammatory cells
Also used for early, mild R.A in combination with methotrexate and / or hydroxychloroquine.

Question 12

what do TNF-a inhibitors do to reduce effects of RA

Answer 12

Shown to decrease signs and symptoms of R.A, reduce progression of structural damage, and improve physical function.
by inhibiting the TNF-a

Question 13

what are the risks of using TNF-a inhibitors

Answer 13

increased risk for infections (tuberculosis, sepsis), fungal opportunistic infections, and pancytopenia.

Question 14

what is the mechanism of action of adalimumab

Answer 14

antibody that binds to TNF-α, thereby interfering with endogenous TNF-α activity by blocking its interaction with cell surface receptors

Question 15

what is the mechanism of action of etanercept

Answer 15

Genetically engineered, soluble, recombinant, fully human receptor fusion protein that binds to TNF-α, thereby blocking its interaction with cell surface TNF-α receptors.

Question 16

what is the mechanism of action of golimumab

Answer 16

neutralizes the biological activity of TNF-α by binding to it and blocking its interaction with cell surface receptors.

Question 17

what is the mechanism of action of infliximab

Answer 17

binds specifically to human TNF-α and inhibits binding with its receptors. Approved for use in combination with methotrexate in patients with RA who have had inadequate response to methotrexate monotherapy.

Question 18

what is the mechanism of action of Anakinra which is a IL-1 receptor antagonist

Answer 18

Anakinra treatment leads to a modest reduction in the signs and symptoms of moderate to severe R.A in patients, Used in DMARDs failure cases, Less clinically effective than TNFα inhibitor

Question 19

why are corticosteroids used to treat RA

Answer 19

Can be inducted at any stage in R.A along with first / second line drugs

Commonly used in patients with R.A to provide symptomatic relief and bridge the time until DMARDs are effective

Question 20

how are corticosteroids administered

Answer 20

In case of single/few joint involvement with severe symptoms, intra-articular injection of glucocorticoid afford relief for several weeks, joint damage may be slowed

Question 21

how do we choose which drug to use dependant of how far the patient is

Answer 21

In low disease activity: Monotherapy may be initiated with any of the DMARDs

In moderate to high disease: activity or inadequate response to monotherapy: combination DMARD therapy or use of anti-TNF drugs

For patients with more established disease, use of other biologic therapies (Non-TNF like abatacept, rituximab) can be considered.