Therapeutic aspects of RA

Question 1

Treatment of Inflammatory Arthritis (different ways) (4)

Answer 1

Medicines
Injections
Therapies
Surgery

Question 2

Therapeutic Categories (4)

Answer 2

1. Non steroidal anti inflammatory drugs (NSAID)
   - symptom controlling

2) Disease Modifying anti Rheumatic drugs (DMARD)
3) Biologics
4) Corticosteroids (oral, i-m, i-a)

Question 3

What is DMARD

• what are they?

Answer 3

Disease Modifying Anti Rheumatic Drugs

slow onset effect on disease activity and retard disease progression.

Question 4

DMARD - give examples (4)

Answer 4

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide

Question 5

Approach to management ?

effective suppression of inflammation will?

Answer 5

Early and aggressive intervention

Effective suppression of inflammation will improve symptoms and prevent joint damage and disability

Question 6

What’s so special about Methotrexate?

what does it work well with?

Answer 6

Effective compared to other drugs, well tolerated and severe toxicity is rare

• cheap
• Cornerstone of combination treatment (with DMARD and biologic)
• people stay on it

Question 7

Early and Aggressive Treatment of RA - Treatment Strategies (3)

Answer 7

• Sequential Monotherapy
• Combination: step up, step down and parallel
• Treat to Target

Question 8

How do Biologics in Arthritis work

Answer 8

large - need to be given by injection or infusion

• rapidly
• generally well tolerated
• high cost

Question 9

Examples of biologics? (6)

Answer 9

• TNFa inhibitors (x5)
• IL-1 inhibitors (Anakinra)
• Anti B Cell therapies (CD20, Rituximab)
• Anti T Cell therapies (Abatacept)
• IL-6 inhibitors (Tocilizumab)
• Oral kinase inhibitors

Question 10

Issues with biologics? (3 main)

Answer 10

very effective in general with patients

• Efficacy: enhanced response when co prescribed with Mtx

Toxicity:

• minor eg injection site reaction
• Infection
• Malignancy

Cost: £9500 v £50

Question 11

Corticosteroids - how can they be prescribed?

Answer 11

mouth, by i-a or i-m injection and by i-v infusion

• Short term benefit v long term toxicity
• rarely used as a single drug therapy

Question 12

What is RA associated with? (3)

Answer 12

disability, high personal and societal costs and premature death

Question 13

Effective use of modern therapeutics including…. have?

Answer 13

traditional and biologic DMARD has transformed outcomes.