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LOCO2 > Treatment Options for RA > Flashcards

Treatment Options for RA Flashcards

1
Q

What are DMARDs?

A

Disease modifying anti-rheumatic drugs

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2
Q

What parts of the body does RA affect?

A
  • joints
  • tendon sheaths
  • other body organs
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3
Q

Why does RA affect body organs?

A
  • affects any membrane with similar structure to synovium so serous membranes around heart/GI system are affected
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4
Q

How is RA symmetrical?

A
  • cytokine disease
  • spreads from distal to proximal joints
  • vertebral bodies damaged frequently as midline
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5
Q

What are the 2 main methods of management?

A
  • pain relief -> same guidelines as OA

- DMARDs to modify disease progression

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6
Q

What is the gold standard DMARD?

A

Methotrexate

  • cannot give in pregnancy
  • start within 3 months of symptoms starting
  • combined with other for mild RA
  • combined with TNFa inhibitor for moderate
  • combined with rituximab for severe
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7
Q

What are some additional therapies?

A
  • physiotherapy
  • occupational therapy
  • podiatry
  • therapy (stress management, relaxation, coping)
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8
Q

What is methotrexate? Mechanism of action

A
  • folic acid antagonist
  • enters the cell polyglutamated
  • prevents production of DNA and RNA synthesis during cell mitosis by inhibiting dihydrofolate reductase and thymidylate synthase
  • used in chemotherapy
  • blocks production of pro-inflammatory cytokines
  • stops production of additional synoviocytes
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9
Q

What are the side effects of methotrexate?

A
  • liver problems

- affects blood count

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10
Q

What is the dosage for methotrexate?

A
  • orally once a week on same day
  • loading dose = 5-10mg a week
  • maintenance dose = 2.5mg tablet
  • if oral ineffective -> subcutaneous or IM injection
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11
Q

What is sulfasalazine?

A
  • DMARD

- old sulphur antibiotic

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12
Q

What is the mechanism of action of sulfasalazine?

A
  • not well understood
  • not well absorbed across gut
  • metabolised by gut bacteria to 5-ASA
  • inhibits COX, cytokines, IL-1 and TNFa in gut modulating travel sites where they produce joint inflammation
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13
Q

What is 5-ASA?

A
  • metabolite of sulfasalazine
  • treats ulcerative colitis and relieves arthritic symptoms
  • role in the gut
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14
Q

What is hydroxychloroquine?

A
  • anti-malarial

- DMARD

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15
Q

What is the mechanism of action of hydroxychloroquine?

A
  • accumulates in lysosomes increasing pH -> decrease protein modifications of precursors which are secreted with cytokines
  • block TLR9 decreasing dendritic cell activation which signal to B cells and lymphocytes
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16
Q

What are the side effects from hydroxychloroquine?

A
  • rash
17
Q

What is the dosage for hydroxychloroquine?

A
  • 400mg daily

- reduced to 2-3 times a week

18
Q

What is leflunomide?

A
  • similar efficacy to methotrexate

- DMARD

19
Q

What is the mechanism of action of leflunomide?

A
  • inhibits DNA and RNA synthesis through inhibiting pyrimidine biosynthesis
20
Q

What are gold salts?

A
  • IM injectiosn once a week
  • 4-6 months before effects seen
  • unknown mechanism of action
  • side effects
21
Q

What are some examples of TNFa blockers?

A
  • etanercept
  • infliximab (monoclonal antibody against TNFa)
  • adalimumab (TNFa monoclonal antibody binding TNF soluble and bound)
22
Q

What are some examples of IL-1 blockers?

A
  • anankinra (human recombinant IL-1 receptor antagonist)
  • canakinumab (human monoclonal antibody IL-1 beta)
  • rilonacept
23
Q

Who are B cells blockers for?

A
  • patients who fail to respond to one or more anti-TNF alpha agents
24
Q

What is an example of a B cell blocker?

A
  • rituximab
  • destroys both normal and malignant B cells
  • in combination with methotrexate
  • effects seen around 3 months after infusions
25
Q

What is an example of a T cell blocker?

A
  • abatacept
    (activates negative switch of CTLA-4 signal stopping T cell)
  • betalacept
26
Q

What is an example of an IL-6 inhibitor?

A
  • tocilizumab

LOCO2 (26 decks)

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