Rheumatoid arthritis and osteoarthritis (Drugs)

Question 1

What are the types of drugs used to treat rheumatoid arthritis (RA)?

Answer 1

1. Symptom-treating drugs
2. Disease-modifying antirheumatic drugs (DMARDs)

Question 2

What are the drugs used to treat RA symptoms?

Answer 2

1. NSAIDs
2. Penicillamine
3. Gold compounds
4. Infliximab/adalimumab
5. Anakinra

Question 3

What is the mechanisms of action of NSAIDs in treatment of RA?

Answer 3

1. Decreased transcription of IL-1 and TNF resulting in reduced inflammation
2. Decreased transcription of IL-2 resulting in decreased T_H cell proliferation

Question 4

What are examples of NSAIDs used in treatment of RA?

Answer 4

Diclofenac (combined with misoprostol to give arthrotec)

Question 5

What is the mechanisms of action of penicillamine in treatment of RA?

Answer 5

1. Inhibits IL-1 synthesis and thus inflammation
2. Inhibits production of collagen

Question 6

What is the mechanisms of action of gold compounds in treatment of RA?

Answer 6

May decrease inflammation by decreasing IL-1 and TNF production

Question 7

What is the mechanisms of action of infliximab/adalimumab in treatment of RA?

Answer 7

Anti-TNF antibody that inhibits TNF binding to TNF receptor and inflammation

Question 8

What is the mechanisms of action of anakinra in treatment of RA?

Answer 8

Inhibits IL-1R and thus inhibits IL-1 mediated inflammation

Question 9

What are examples of gold compounds used in treatment of RA?

Answer 9

1. Sodium aurothiomalate (IM injection)
2. Auranofin (tablet)

Question 10

What are the DMARDs?

Answer 10

1. Methotrexate
2. Sulfasalazine
3. Hydrochloroquine
4. Etanercept
5. Rituximab

Question 11

What is the mechanisms of action of methotrexate in treatment of RA?

Answer 11

Inhibits DHFR in folate metabolism pathway and inhibits proliferation of T_H cells

Question 12

What is the mechanism of action of sulfasalazine in treating RA?

Answer 12

• Pro-drug broken down by gut flora to sulfapyridine and 5-aminosalicylic acid.
• 5-aminosalicylic acid scavenges ROSs released from neutrophils and reduces damage.

Question 13

What is the mechanisms of action of hydrochloroquine in treatment of RA?

Answer 13

Accumulates in cytoplasmic acidic vesicles and may:

1. Reduce antigen presentation by macrophages
2. Reduce ROS production by neutrophils

Question 14

What is the mechanism of action of etanercept in treating RA?

Answer 14

Recombinant TNF receptor/IgG1 that sequests TNF

Question 15

What is the mechanisms of action of rituximab in treatment of RA?

Answer 15

Monclonal antibody targeting CD20 in B cells for destruction

Question 16

What is the mechanisms of action of tocilizumab in treatment of RA?

Answer 16

Monoclonal antibody that binds to and inhibits IL-6R

Question 17

What is the mechanism of action of NSAIDs in the treatment of OA?

Answer 17

Reduces inflammation and pain

Question 18

What are examples of NSAIDs used in treatment of OA?

Answer 18

• Dicofenac
• Etroicoxib

Question 19

What is the mechanism of action of caspaicin in the treatment of OA?

Answer 19

Topical application causes activation of TRPV1 channels in nociceptors leading to depolarisation block of nociceptors and analgesic effect

Question 20

What is the mechanism of action of tanezumab in the treatment of OA?

Answer 20

Anti-NGF monoclonal antibody that binds to and inhibits NGF-mediated sensitisation of nociceptors, thus has analgesic effect.

Question 21

What are the non-pharmacological treatments for OA?

Answer 21

1. Autologous chondrocyte transplantation
2. Injection of bone marrow-derived stem cells
3. Athroplasty (joint replacement)