Rheumatoid Arthritis Treatments Flashcards
Name the 3 categories of rheumatoid arthritis therapies.
NSAIDs, DMARDs (disease-modifying anti-rheumatic drugs), and biologic response modifiers
Indomethacin, naproxen, celecoxib, and other NSAIDs can be used to treat what 2 symptoms of rheumatoid arthritis and acute gouty arthritis? What aspect of these diseases do they not treat?
Treat pain and inflammation; do not slow disease progression
Why are the COX-2 selective NSAIDs becoming a more popular treatment for rheumatoid arthritis than the non-selective NSAIDs?
50% less side effects of gastric and duodenal ulcers
Name 6 DMARDs (disease-modifying anti-rheumatic drugs) that can be used to treat rheumatoid arthritis.
Gold salts, quinolones, glucocorticoids/corticosteroids, sulfasalazine, methotrexate, and leflunomide
Which DMARD is antipruritic and represses macrophage function, but is rarely used today because it causes serious side effects in 30% of patients?
Gold salts
The quinolones are both anti-malarials and rheumatic disorder DMARDs. By what mechanisms do they achieve these 2 separate therapeutic functions?
Antimalarial: accumulates in the food vacuoles of Plasmodium and cause oxidative damage
DMARD: reduce T-cell activation and chemotaxis
Give one reason a patient would be prescribed a quinolone for rheumatoid arthritis, and one possible side effect if chloroquine was the quinolone prescribed.
Quinolones can be used if the patient is no longer responding to NSAIDs [or can’t tolerate gold or penillamine]; possible side effect is retinal damage
What DMARD class can, like NSAIDs, be used to treat both rheumatoid arthritis and acute gouty arthritis? What 2 pathways does this DMARD target?
Corticosteroids/glucocorticoids; inhibits phospholipase A2 (which makes arachidonic acid) and cytokine production (which induces COX-2) pathways
By what mechanism does the DMARD sulfasalazine help treat rheumatoid arthritis?
Inhibit TNF-α and IL-1 release
Name the 2 immunosuppressive DMARDs. Which one inhibits aminoimidazolecarboxamide (AICAR) transformylase, thymidylate synthetase, and PMN chemotaxis while increasing adenosine accumulation (which is anti-inflammatory)?
Methotrexate and leflunomide; methotrexate has all these actions (note: DHFR inhibition is not seen at these low doses)
Which DMARD acts by inhibiting dihydroorotate dehydrogenase (DHODH)? What molecules are not synthesized and what cells’ response to stimuli are inhibited as a result?
Leflunomide; inhibits de novo pyrimidine (UMP) synthesis which inhibits T-cell response to stimuli
Which of the following DMARDs is fastest acting: corticosteroids, sulfasalazine, methotrexate, or leflunomide?
Corticosteroids (sulfasalazine takes about 1 month and methotrexate & leflunomide both take several weeks to have an effect)
Which DMARD can cause Cushing syndrome-like symptoms as a side effect?
Corticosteroids/glucocorticoids
Which class of DMARDs can cause GI problems like nausea, stomatitis, and diarrhea, and also liver problems?
The immunosuppressives (methotrexate and leflunomide)
30% of patients discontinue use of which DMARD because of nausea, vomiting, skin rashes, neutropenia, and headaches?
Sulfasalazine