Wk 26 - Rheumatoid arthritis + Osteoarthritis Flashcards
What are the associated conditions of RA?
- Sjörgrens syndrome
- Vasculitis
- Inc CV risk
- Inc osteoporosis
Which supportive treatments are used for RA?
- NSAIDs + COX-2 inhibitors
- Steroids: flare ups
What is the DAS-28?
Reviews disease activity score - based on how many swollen/tender joints patient has
What are the initial pharmacological treatment for RA?
- Monotherapy
- Oral MXT, leflunomide or sulfasalazine
When adding a second DMARD, which 2 can’t be used alongside one another?
MXT + leflunomide
How long do DMARDs take to work?
Upto 12 weeks
What are the general points when taking DMARDs in regards to vaccination?
- Flu, pneumococcal recommended
- Avoid live (2-4 wks before starting)
- Avoid chicken pox/shingles/measles
- VZ immunoglobulin can be given w/in 7 days
Which medication given for RA may have a risk of reactivating latent TB?
Biologics
What happens when a patient is on a DMARD + gets ill?
Stop until infection cleared
Which DMARDs are CI in pregnancy?
MXT + leflunomide
Which therapy is given for pregnant women w/ RA?
Azathioprine or hydroxychloroquine
When taking leflunomide, how long must the patient use effective contraception before becoming pregnant?
- Women: during treatment + 2 years after
- Men: 3 months after
Which conditions may improve/worsen RA?
- Pregnancy improves
- Lupus worsens
What are the advice when taking MXT + NSAIDs?
- NSAIDs reduce renal excretion of MXT
- Avoid inappropriate clinical use: post surgical pain relief, OTC
- Monitor bloods + signs of haem/liver/pulmonary toxicity
What are the counselling points for MXT?
- Once weekly
- Folic diff. day
- S/e: sick, upset stomach/di
When would you report + tell your doctor when taking MXT?
- Unexplained SOB + dry cough
- Jaundice
- Fever, chills, sore throat
- Mouth ulcers, bleeding gums, bruising
- Never had chickenpox + exposed
- Pregnant
What is given for MXT rescue therapy?
- Folinic acid (calcium folinate)
- Counteracts anti-folate activity of MXT, speeds recovery of myelosuppression/mucositis
What is given for severe neutropenia when taking MXT?
SC filgrastim
What are the counselling points for sulfasalazine?
- Dose: 500mg OD 7/7, 500mg BD 7/7, 1g OM + 500mg ON 7/7, 1g BD
- Turns urine orange, contacts + tears yellow
- S/e: nausea, di, upset stomach
- FBC, LFTs + U+Es first 2 yrs
- Report: unexplained cough, sore throat, rash
Which conditions would you not use leflunomide?
Liver impairment + hypoproteinemia
When taking leflunomide, other than FBCs, what else needs to be monitored?
BP + weight monitoring
What is used for a leflunomide wash out?
- Cholestyramine 8g TDS 11 days
OR
- Activated charcoal 50g QDS 11 days
When completing a leflunomide wash out, what must the concentration of active metabolites be?
<20microg/L on 2 occasions 2 wks apart
Which DMARD may cause ocular disturbances?
Hydroxychloroquine - Visual acuity tested annually (high risk) or every 5 years
