Treatment of rheumatoid arthritis

Question 1

What medications are used to treat osteoathritis?

Answer 1

NSAIDS
Disease modyfying anti rheumatic drugs (DMARD)
Biologics
Corticosteroids (oral, i-m, i-a)

Question 2

What are DMARD’s

Answer 2

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.

Question 3

What are some examples of DMARD’s

Answer 3

Methotrexate
Sulfasalazine
Hydroxchloroquine
Leflunomide (main ones)

Also peniciilamine, myocrisin

Question 4

What is the key of rheumatoid arthritis treatment

Answer 4

Early and aggressive

Suppression of inflammation will improve symptoms and prevent joint damage and disabilty

Question 5

What is the treatment pyramid for rheumatoid arthritis

Answer 5

Top- steroid
Azathiprine/Methorexate
Gluthathione/Pen?
Sulfasalzine/Hydroxychloroquine
NSAID

Question 6

Why is methotrexate a good drug for RA?

Answer 6

Effective, well tolerated and cheap
cornerstone of combined treatment with biologic
people stay on it

Question 7

How are biologics used in arthrits

Answer 7

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)

Question 8

What are some examples of biologics in the treatment of RA

Answer 8

TNFa inhibitors
IL-1 inhibitors (anakinra)
Anti-B cell therapues (CD20, rituximab)
Anti T cell therapies (abatacept)
IL-6 inhibitors (tocilizumab)

Question 9

What are the issues with biologics

Answer 9

Enhanced response when co-prescribed with methotrexate
Toxicity: minor e.g. injection site reaction
Infection
? malignancy
Cost £9500 vs £50

Question 10

How are corticosteroids used

Answer 10

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

Question 11

How may a patient present with RA

Answer 11

Any age
join pain
morning stiffness that doesnt easily wear off
difficulty doing simple tasks

Question 12

What biological factors would suggest an invdividual has RA

Answer 12

Raise ESR, CRP
Positive RF
Positive CCP (cyclic citrullinated antibody)

Question 13

What investigations are undertaken in someone with susepcted RA

Answer 13

ESR,CRP,Positive RF, positive anti CCP

baseline hand and foot x-rays

Question 14

What does a flare up of RA present?

Answer 14

joint swelling
widespread synovitis
Unable to lift arms
Effusions
Unable to mobilise and requires help with activities of daily living`

Question 15

What initial action is taken if someone presents with RA

Answer 15

Glucocorticoids are given
Inhalation of DMARD’s
Patient information

Question 16

What are the next stages of management in RA?

Answer 16

Early arthritis cliic
Monthly appointments
Monitoring disease activity
Monitoring blood tests
Patient education
Multidisciplinary assessment

Question 17

Who is involved in the MDT for the treatment of rheumatoid arthritis?

Answer 17

Rheumatology specialist nurse
Rheumatology occupational therapist
Rheumatology physiothearpist
Pharmacist
Clinical psychologist
Podiatrist
Orthotics

Question 18

What other pathologies may arise due to orthopaedic involvement

Answer 18

Chronic synovitis
Mechanical deformities
Secondary osteoathritis
Poor function
Pain

Question 19

What other patholiges may arise due to RA?

Answer 19

Rheumatoid nodules
interstitial lung disease
Vasculitis
Cardiovascular risk

Question 20

What socio-economic impacts may be incurred due to oseteoarthrits?

Answer 20

Direct cost to NHS
Indirect cost to economy
Personal impact and subsequent complications for patients and their families

Question 21

What special equipment may be needed to treat

Answer 21

Adaptive cutlery
Special footwear
Walking aids
Wheelchair outdoors
Care package
Carers