Treatment of Inflammatory Arthritis

Question 1

4 main classes of drugs to treat RA

Answer 1

NSAIDs
DMARDs
Analgesics
Corticosteroids

Question 2

Extra articular RA manifestations

Answer 2

Nodules
Eye inflammation
Interstitial lung disease
Sicca symptoms
Vasculitis 
Pleuritis
Pericarditis
Neuropathy

Question 3

Poor prognostic signs for RA

Answer 3

Vulnerable population
Delay in Dx
Female
Obesity
Smoker
High RF, antiCCP
Erosions
Nodules
Other extra articular manifestations

Question 4

Non pharm therapy for RA

Answer 4

Education
Nutrition
Exercise
Rest
Physiotherapy
OT

Question 5

Analgesics for RA

Answer 5

Fast acting
Do not reduce inflammation or prevent joint damage
Ex: acetaminophen or opioids

Question 6

NSAIDs for RA

Answer 6

Both analgesic and anti-inflammatory properties
Fast acting
Do NOT alter disease outcomes/prevent joint damage
Ineffective as sole therapy
Side effects and drug interactions are common

Question 7

Glucocorticoids for RA

Answer 7

Used to suppress inflammation
Fast acting
No analgesic effect (but less inflam = less pain)
Systemic effect of RA is reduced
Ideal for rapid treatment of life threatening RA complications
Oral, IV, or intraarticular

Question 8

What are some
1. Early
2. Late
side effects of GCs?

Answer 8

1. Mood disturbance, hyperglycemia, blurred vision, hypokalemia, osteonecrosis
2. OP, cushingoid features, HTN, increased CV risks, osteonecrosis, cataracts

Question 9

Disease modifying anti-rheumatic drugs (DMARDs)

Answer 9

Miscellaneous group of drugs
Reduce or prevent joint damage and preserve joint integrity/function
Maintain functional level of the patient
Reduce overall health costs

Question 10

4 small molecule DMARDs

Answer 10

MTX
Hydroxychloroquine
Sulfasalazine
Leflunomide

Question 11

Hydroxychloroquine

Answer 11

For RA and lupus
Affects T cell lysosomes and inhibits degranulation
Reduces T cell proliferation and IL 1 production

Question 12

Methotrexate

Answer 12

Best first option for RA
Weekly med
Inhibits dihydrofolate reductase and thereby reduces pyrimidine synthesis (inhibits proliferation of cells)
Teratogenic

Question 13

Triple therapy for RA

Answer 13

For moderate RA
MTX
Hydroxychloroquine
Sulfasalazine
These 2 together are just as effective as 1 of the biologic DMARDs (and they are WAY cheaper and safer)

Question 14

Treatment of mild-moderate RA

Answer 14

MTX or triple therapy usual options

Bridging GCs can be used

Question 15

Severe RA treatment

Answer 15

Triple therapy initially, switch MTX to leflunomide if not tolerated
Treat life threatening extra articular disease with oral or IV steroids while waiting for DMARD benefit
Add biologics if no response

Question 16

Characteristics of severe RA

Answer 16

More than 20 inflamed joints
Rapidly declining functional capacity
Elevated ESR and/or CRP
Anemia of chronic disease
Hypoalbuminemia
Positive RF or anti-CCP