Rheumatoid arthritis treatment

Question 1

what are the general principles of RA treatment

Answer 1

early recognition and diagnoses, refer to rheumatologist, tight control aim for remission or low disease activity, patient education

Question 2

what treatment are all RA patients given

Answer 2

early treatment with Disease Modifying Anti-Rheumatic Drugs(DMARDs)

Question 3

what drugs can be used as adjuncts in RA

Answer 3

NSAIDs and steroids

Question 4

what period of RA development provides a therapeutic window of oppurtunity

Answer 4

first 3 months of disease

Question 5

describe the progression of RA treatment

Answer 5

keep adding DMARDs if symptoms persist until patient is on 3

can then consider biologic therapy

Question 6

what is involved in the initial management of RA

Answer 6

aspirin/NSAIDs, + steroids + DMARD

Question 7

what happens to drug treatment of RA when remission is seen

Answer 7

gradually reduce drug treatment

Question 8

how long does the rig treatment of RA usually last

Answer 8

usually life-long treatment(95%)

Question 9

what drugs are Disease Modifying Anti-Rheumatic Drugs(DMARDs)

Answer 9

methotrexate, sulfasalazine, hydroxychloroquine, leflunomide, steroids

Question 10

what DMARDs are given in combo in progression of RA treatment

Answer 10

methotrexate, sulfasalazine and hydroxychloroquine

Question 11

what is a feature of hydroxychloroquine in RA treatment

Answer 11

does not prevent erosion

Question 12

what are some of the side effects of DMARDs

Answer 12

bone marrow suppression, infection, liver function derangement

Question 13

what side effect can be seen with methotrexate

Answer 13

methotrexate = pneumonitis

Question 14

what disease should sulfasalazine be avoided with

Answer 14

septrin allergy and G6PD deficiency

Question 15

what types of biologic agents are used in RA treatement

Answer 15

anti-TNF agents, T cell receptor blockers, B cell depletor, IL-6 blocker, JAK 2 blocker

Question 16

give an example of an anti-TNF agent and a T cell receptor blocker

Answer 16

anti-TNF = infliximab

T cell receptor blocker = abatacept

Question 17

describe the meaning of different DAS-28 scores

Answer 17

<2.6 = remission
2.6-3.2 = low disease activity
3.2-5.1 = moderate disease activity
>5.1 = active disease

Question 18

in UK what qualifies patients for biologic therapy

Answer 18

if DAS-28 score > 5.1 despite 2 DMARDs, one of which methotrexate

Question 19

when are steroids used in RA

Answer 19

as bridging therapy and for flares only