Therapeutic approach to RA Flashcards
What are the 4 main categories of treatment options for RA?
- Medication
- Injections (i.e steroid injections)
- Physio, OT, psychology, pharmacy etc MDT is key to treatment
- Surgery
What are the 4 main classes of drugs used for RA?
- Non steroidal anti inflammatory drugs (NSAID)
- Disease Modifying anti-rheumatic drugs (DMARD)
- Biologics
- Corticosteroids (i-m, i-articular and rarely oral) - try to minimise the use of these
What is the purpose of NSAID use?
Symptom control/relief
Why are DMARDs used?
Over time they have an effect on disease activity (reduce it) and prevent the progression of damaging disease/disability
What is the gold standard DMARD commonly used nowadays?
Methotrexate
What is the most important thing in terms of treatment of RA nowadays?
Treatment needs to be early and aggressive in order to have a better outcome and prevent damaging disease Also treatment is by MDT approach
Why is methotrexate the gold standard drug?
It’s effective, well tolerated and cheap! It can be used in combination with other treatment (with DMARD and biologic)
People stay on it
Issues with biologics (3)
- Efficacy: interact with methotrexate => enhanced response
- Toxicity: minor eg injection site reaction or Infection
- Cost: £9500 v £50
How do Biologic DMARDs work in comparison to traditional DMARDs?
They work rapidly, are generally well tolerated although with important toxicities (eg infection) and they come at a high cost
How do biologics work in RA?
They work by targeting particular chemicals and cells that are known to be important in inflammation. There are now four different types of biologic drugs available in the UK:
TNF inhibitors i.e adalimunimab, infliximab
Also L-6 blockers, B-cell therapy and T-cell therapy.
Why might someone be put onto a biologic DMARD?
- Not all DMARDs can stop joint damage, and they do not always significantly improve quality of life.
- If they don’t respond to 1st line therapy (up to 40% of people do not respond to methotrexate / experience side effects)
What is the 1st, 2nd, 3rd and 4th line treatment for RA?
- First line = monotherapy with methotrexate, leflunomide or sulfasalazine
- 2nd line = 2 of the above used in combination
- 3rd line = Methotrexate + biologic (TNF inhibitor)
- 4th line = Rutiximab (a biologic)
Which 2 drugs can be used to treat RA in pregnant women?
- Sulfasalazine
- Hydroxychloroquine
Important biologics to remember
- TNF inhibitors such as adalimumab, infliximab and etanercept (3rd line)
- Rutiximab (4th line)
The use of biologics can lead to what in patients?
Immunosuppression - patients become prone to serious infections
- It can also cause the reactivation of TB or Hep B
N.B biologics are immunosuppressive drugs
