Treatment of RA: adverse reaction

Question 1

Corticosteroids (CS)

Answer 1

Cataracts, glaucoma, thinned skin, striae, diabetes, hirsutism, acne, hypertension, weight gain, HPA axis suppression, myopathy, GI, cardiovascular, infectious, neurologic complications, osteonecrosis

Question 2

Methotrexate (MTX)

Answer 2

• Hepatotoxicity
• Pulmonary toxicity
• Fetal abnormalities
• Gastrointestinal, stomatitis, hematologic, rash, alopecia, CNS effects, Nephrotoxicity, rash, oligospermia, gynecomastia, localized osteoporosis

Question 3

Sulfasalazine (SAS, SSZ)

Answer 3

• GI effects common,

- rash, photosensitivity, Dizziness, headache, reversible oligospermia, megaloblastic, hemolytic, aplastic anemias

Question 4

Leflunomide (Arava)

Answer 4

• Increased liver enzymes
• Teratogenicity
• GI (diarrhea, nausea, abdominal pain), hypertension, reversible alopecia, rash, headache, paresthesias, Stevens-Johnson syndrome, toxic epidermal necrolysis, bone marrow suppression

Question 5

Hydroxychloroquine

Answer 5

• Retinal damage

- GI side effects, rash, insomnia, myopathy, rarely leukopenia

Question 6

Minocycline

Answer 6

Hyperpigmentation, photosensitivity, dizziness, vaginal yeast infection; may decrease efficacy of oral contraceptives

Question 7

Cyclosporine (CY)

Answer 7

• Nephrotoxicity
• hypertension
• gingival hyperplasia
• hyperkalemia
• hyperuricemia
• hypomagnesemia, gastrointestinal problems, neuropathies, hirsutism

Question 8

Azathioprine

Answer 8

• leukopenia (dose related)

- Gastrointestinal upset, thrombocytopenia

Question 9

Gold

Answer 9

Toxicity, diarrhea

Question 10

D-penicillamine

Answer 10

Toxicity

Question 11

Cyclophosphamide

Answer 11

Toxicity, risk of malignancy

Question 12

Tofacitinib

Answer 12

• Increased LDL cholesterol
• increased LFTs
• GI perforation
• Herpes zoster
• neutropenia/bone marrow suppression, headache, diarrhea, Tb

Question 13

Baricitinib

Answer 13

• Increased LDL cholesterol
• increased LFTs
• GI perforation
• Herpes zoster
• neutropenia/bone marrow suppression, headache, diarrhea, Tb
• black box warning about thrombosis (DVT, PE, arterial)

Question 14

Etanercept

Answer 14

Injection site reactions (rash); upper respiratory tract symptoms

Question 15

Infliximab

Answer 15

Acute infusion reactions, hypersensitivity, increased infection risk, + ANA, lupus (rare), leukopenia, neutropenia, thrombocytopenia, pancytopenia

Question 16

Adalimumab

Answer 16

Injection site or allergic reactions, headache, rash, sinusitis

Question 17

Golimumab

Answer 17

Upper respiratory infection, sore throat, nasal congestion

Question 18

Certolizumab pegol

Answer 18

Upper respiratory & other infections, headache, nausea, diarrhea

Question 19

Rituximab

Answer 19

Infusion reactions, neutropenia, lymphopenia, thrombocytopenia, anemia, weakness, serious infections, and mucocutaneous reactions; reactivation of hepatitis B; warning about progressive multifocal leukoencephalopathy

Question 20

Abatacept

Answer 20

• COPD exacerbations

- Serious infections, infusion-related reactions

Question 21

Tocilizumab

Answer 21

• GI perforation
• upper respiratory infections, nasopharyngitis, headache, hypertension, ↑ liver enzymes / lipids, decreased neutrophils / platelets, infections

Question 22

Sarilumab

Answer 22

↑ liver enzymes / lipids, decreased neutrophils / platelets, infections,

Question 23

Anakinra

Answer 23

neutropenia, serious infections, injection site reactions – dose-related skin irritation