Rheumatoid Arthritis and Osteoarthritis Flashcards
Name the csDMARDs
Methotrexate
Hydroxychloroquine
Sulphasalazine
Leflunomide
Name some of the biologic DMARDs
Adalimumab
Certolizumab
Etanercept
Golimumab
Infliximab
Name a tsDMARD
Tofacitinib
How does rheumatoid arthritis present?
Inflammation of the joints, tendons and bursae - initial inflammation in the joints of the hands and feet. Leads to early morning joint stiffness, decreased range in motion.
Extra-articular effects: fatigue, subcutaneous nodules, lung symptoms and conditions, pericarditis and anaemia of chronic disease.
How does Methotrexate manage RA? What are some side effects?
cytotoxic: inhibits folate metabolism (inhibits purine synthesis)
anti-inflammatory: inhibits cytokine production
supplement with folic acid to reduce some side effects
AE: increased risk of infection, nausea, mouth ulcers, hepatotoxicity, pneumonitis, pulmonary fibrosis, rash, and photosensitivity
How do biologic DMARDs manage RA?
TNF-α inhibitors: adalimumab, certolizumab, etanercept, golimumab, infliximab
IL-1 receptor antagonist: anakinra
antibody to IL-6 receptor: tocilizumab
T or B cell modulators: abatacept, rituximab
AE: increased risk of infection, heart failure and interstitual lung disease
Effect seen in 2-4 or 4-8 weeks
What joints are most commonly affected in rheumatoid arthritis?
Joints of the hands, wrists, and small joints of the feet.
Shoulders, elbows, knees and ankles also affected in many patients.
How is RA diagnosed?
Amount of rheumatoid factor and anti-CCP present
Number and types of joints involved
Elevation of C-reactive protein
Erythrocyte sedimentation rate increases with acute-phase reactants (infection and inflammation)
How does Hydroxychloroquine manage RA? What are some adverse effects?
Less side effects than Methotrexate
Reduces inflammatory response - reduces release of cytokines
AE: Nausea, vomiting, diarrhoea, ocular toxicity, haemolysis (G6DP deficiency)
Retinopathy is rare and reversible - eye tests on initiation of treatment
Effects seen in 2-6 months.
How does Sulfasalazine manage RA? What are some adverse effects?
Inhibits various inflammatory molecules.
AE: nausea, vomiting, diarrhoea, anorexia, headache, reversible male infertility
Rare: haemolysis, hypersensitivity reaction, and hepatitis
Effects seen in 2 months
How does Leflunomide manage RA? What are some adverse effects?
Cytotoxic and immunosuppressive - blocks pyrimidine synthesis inhibiting DNA production
AE: liver, lung, haematological effects (similar to methotrexate)
Effects seen in 4-12 weeks
What is Osteoarthritis?
Joint failure characterised by loss of cartilage, variable levels of inflammation, and weakness in muscles stabilising the joint.
What joints are affected in Osteoarthritis?
Joints in the hands, back, knee and hip
How is Osteoarthritis managed?
Treatment focused on reducing symptoms and optimising function
* Exercise and weight loss
* Topical NSAIDs
* Oral NSAIDs (adverse effects from long-term use is challenging)
* Paracetamol (limited evidence)
