Rheumatoid Arthritis - Therapeutic aspects Flashcards
RA - Therapeutic categories?
1) Non steroidal anti inflammatory drugs (NSAID)
2) Disease Modifying anti Rheumatic drugs (DMARD)
3) Biologics
4) Corticosteroids (oral, i-m, i-a)
RA Therapeutics, what is - Disease modifying anti-rheumatic drugs (DMARD)?
A group of structurally unrelated, typically small molecule drugs which have been demonstrated to have slow onset effect on disease activity and retard disease progression.
Traditionally, these have been associated with identifiable toxicity profiles and risk of occasional serious adverse event.
RA Therapeutics, examples -Disease modifying anti-rheumatic drugs (DMARD)?
Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
RA Therapeutics, why is penicillamine no longer used?
Highly toxic
Current approach to RA management?
> Early and aggressive intervention is the key to obtaining optimal outcomes in the management of RA
> Effective suppression of inflammation will improve symptoms and prevent joint damage and disability
What is the most common used drug in RA, why?
Methotrexate (a DMARD
- Effective
- Well tolerated
- Cheap
this means people stay on it
RA Therapeutics, what are - Biologics?
Biologic DMARDs have been developed from improved understanding of immunology to target key aspects of inflammatory cascade.
Typically these are large complex proteins which need to be given parenterally. Compared to traditional DMARD, they work rapidly, are generally well tolerated although with important toxicities (eg infection and come at high cost.
RA Therapeutics, examples- Biologics?
Biologics in 2017
> TNFα inhibitors (x5)
> IL-1 inhibitors (Anakinra)
> Anti B Cell therapies (CD20, Rituximab)
> Anti T Cell therapies (Abatacept)
> IL-6 inhibitors (Tocilizumab)
Other
What is Tocilizumab?
An IL-6 inhibiter (Biologic used in RA)
What is Abatacept?
An anti-T cell therapy (A biological used in RA)
What is Rituximab?
An anti-B cell therapy (A biologic used in RA)
What is Anakinra?
An IL-1 inhibitor (A biologic used in RA)
What is Sulfasalazine?
A Disease modifying anti-rheumatic drug (DMARD)
What are the main issues surrounding using biologics in RA treatment?
> Efficacy: enhanced response when co prescribed with Mtx
> Toxicity: minor eg injection site reaction: Infection; Malignancy
> Cost
Corticosteroids in RA?
Corticosteroids
> Corticosteroids can be prescribed by mouth, by i-a or i-m injection and by i-v infusion
> Short term benefit v long term toxicity
> Rarely appropriate as single drug therapy
Drugs that ease symptoms in RA?
NSAIDs (COX inhibitor)
Drugs That Slow Disease Activity in RA?
> Corticosteroids eg prednisolone = Fast acting and can be used whilst waiting for NSAIDs or DMARDs to take effect
> DMARDs e.g. methotrexate, hydroxycholorquine, sulfasalazine, leflunomide, cyclophosphamide and azathioprine
> Biologics (Require injection)
> JAK inhibitors e.g. Tofacitinib (Can be taken orally)
What is tofacitinib?
A JAK inhibitor (Can be used in RA treatment to slow progression)
What is a last option in RA therapy sometimes?
Surgery - Joint replacement
Complications with RA?
Orthopaedic intervention > Chronic synovitis > Mechanical deformities > Secondary osteoarthritis > Poor function > Pain
Extra-articular involvement
> Rheumatoid nodules
> Interstitial lung disease
> Vasculitis
Cardiovascular risk
Socio-economic
Socio-economic impact of RA?
Direct costs to the NHS and associated healthcare support services
Indirect costs to the economy, including the effects of early mortality and lost productivity
Personal impact and subsequent complications for patients and their families
Approximately one third of people stop work within 2 years of onset
Functional impairment within RA?
Vertebral fractures
