Rheumatoid Arthritis Treatment

Question 1

Therapeutic Categories in Rheumatoid Arthritis

Answer 1

NSAID’s
Disease modifying anti-rheumatic drugs
Biologics
Corticosteroids

Question 2

How long do Disease Modifying Anti-Rheumatic Drugs take to work

Answer 2

3 months

Question 3

Examples of DMARD’s

Answer 3

Methotrexate
Sulfalazone
Hydroxychloroquine
Leflunomid
Gold Salts
Penicillamine

Question 4

What DMARD’s are commonly used and why

Answer 4

Methotrexate and hydroxychloroquine are often used due to their balance between toxicity and efficacy

Question 5

Approach to Management

Answer 5

There should be an early and aggressive intervention, effective suppression of inflammation. This will improve symptoms and prevent joint damage and disability.

Question 6

Methotrexate in Rheumatoid Arthritis

Answer 6

Effective, well tolerated and cheap. It is the cornerstone of combination therapy (DMARD and biologic).

Question 7

Biologics

Answer 7

Large complex proteins which need to be given parenterally. They work rapidly, are generally well tolerated but have important toxicities.

Question 8

Key biologics

Answer 8

TNFalpha inhibitors (etanercept) 
IL-1 Inhibitors (Anakinra)
Anti B cell therapies (Rituximab)
Anti T cell therapies (abatacept)
IL-6 inhibitors (tocilizumab)

Question 9

Efficacy of Biologics

Answer 9

Better when prescribed alongside Methotrexate

Question 10

Toxicity of Biologics

Answer 10

Risk of infection and malignancy

Question 11

Corticosteroids in RA

Answer 11

Short term benefit. These are rarely appropriate as single drug therapy.