Rheumatoid Arthritis Therapeutics

Question 0

Osteoarthritis

Answer 0

Correlated with age
Weight bearing joints
Degenerative joint disease
Hips
Shoulders

Question 1

Rheumatoid arthritis

Answer 1

Younger people
Bilateral inflammation
Small joints- hands and feet
Morning stiffness

Abnormal labs- rheum factor
Increased ESR, CRP

Question 2

NSAIDs

Answer 2

Block prostaglandin synthesis by inhibiting COX

COX1- GI housekeeper
COX2- target

Celecoxib-selective cox2 inhibitor
Less GI toxicity

Meloxicam, nabumetone-unselective

All reduce renal blood flow and may cause renal failure

Monitor for GI, renal, HTN in elderly

Question 3

NSAID analgesic vs. anti inflammatory

Answer 3

Anti inflammatory higher dose longer time of onset

Question 4

Rheumatoid arthritis treatment

Answer 4

1) Methotrexate(DMARD) with steroid (prednisone) bridge therapy
2) etanercept (enbrel) TNF inhibitor
3) non TNF inhibitor

Question 5

Synthetic DMARDs

Answer 5

Methotrexate

Hydroxychlorquine

Question 6

TNF inhibitor (biological DMARDs)

Answer 6

Etanercept (embrel)
Infliximab - only combo w/MTX

May increase rate of TB infection
Contraindicated in MS

Question 7

Non TNF inhibitor (TAR)

Answer 7

Tofacitinib - first oral DMARD
Abatacept
Rituximab

Black box for increased risk of TB