Treatment of rheumatoid arthritis Flashcards
What medications are used to treat osteoathritis?
NSAIDS
Disease modyfying anti rheumatic drugs (DMARD)
Biologics
Corticosteroids (oral, i-m, i-a)
What are DMARD’s
Disease modifying anti rheumatic drugs
group of structurally unrelated, small molecule drugs that have been demonstrated to have a slow onset effect on disease activity and retard disease progression.
What are some examples of DMARD’s
Methotrexate
Sulfasalazine
Hydroxchloroquine
Leflunomide (main ones)
Also peniciilamine, myocrisin
What is the key of rheumatoid arthritis treatment
Early and aggressive
Suppression of inflammation will improve symptoms and prevent joint damage and disabilty
What is the treatment pyramid for rheumatoid arthritis
Top- steroid Azathiprine/Methorexate Gluthathione/Pen? Sulfasalzine/Hydroxychloroquine NSAID
Why is methotrexate a good drug for RA?
Effective, well tolerated and cheap
cornerstone of combined treatment with biologic
people stay on it
How are biologics used in arthrits
Biologic DMARD’s have been developed from improved understanding of immunology to target key aspects of the inflammatory cascade.
Typically large cascade proteins that work rapidly and are generally well tolerated although with important toxicities (e.g. infection)
What are some examples of biologics in the treatment of RA
TNFa inhibitors IL-1 inhibitors (anakinra) Anti-B cell therapues (CD20, rituximab) Anti T cell therapies (abatacept) IL-6 inhibitors (tocilizumab)
What are the issues with biologics
Enhanced response when co-prescribed with methotrexate
Toxicity: minor e.g. injection site reaction
Infection
? malignancy
Cost £9500 vs £50
How are corticosteroids used
can be prescribed by mouth,bi i-a or i-m injection and by i-v infusion
Short term benefit vs long term toxicity
Rarely appropriate as single drug therapy
How may a patient present with RA
Any age
join pain
morning stiffness that doesnt easily wear off
difficulty doing simple tasks
What biological factors would suggest an invdividual has RA
Raise ESR, CRP
Positive RF
Positive CCP (cyclic citrullinated antibody)
What investigations are undertaken in someone with susepcted RA
ESR,CRP,Positive RF, positive anti CCP
baseline hand and foot x-rays
What does a flare up of RA present?
joint swelling widespread synovitis Unable to lift arms Effusions Unable to mobilise and requires help with activities of daily living`
What initial action is taken if someone presents with RA
Glucocorticoids are given
Inhalation of DMARD’s
Patient information
What are the next stages of management in RA?
Early arthritis cliic Monthly appointments Monitoring disease activity Monitoring blood tests Patient education Multidisciplinary assessment
Who is involved in the MDT for the treatment of rheumatoid arthritis?
Rheumatology specialist nurse Rheumatology occupational therapist Rheumatology physiothearpist Pharmacist Clinical psychologist Podiatrist Orthotics
What other pathologies may arise due to orthopaedic involvement
Chronic synovitis Mechanical deformities Secondary osteoathritis Poor function Pain
What other patholiges may arise due to RA?
Rheumatoid nodules
interstitial lung disease
Vasculitis
Cardiovascular risk
What socio-economic impacts may be incurred due to oseteoarthrits?
Direct cost to NHS
Indirect cost to economy
Personal impact and subsequent complications for patients and their families
What special equipment may be needed to treat
Adaptive cutlery Special footwear Walking aids Wheelchair outdoors Care package Carers
