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LOCO > 11 - Treatment Options for Rheumatoid Arthritis > Flashcards

11 - Treatment Options for Rheumatoid Arthritis Flashcards

1
Q

How do you diagnose RA

A

Clinical diagnosis

ACR/EULAR criteria

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2
Q

What are the 4 ACR/EULAR criteria

A 
Joint involvement
Serology 
Acute phase reactants
Duration of symptoms
need >6/10 for diagnosis
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3
Q

How do you manage RA

A

1) Pain relief
2) Modification of disease progression (ASAP)
3) Adjunct therapy

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4
Q

What is the pain relief given in RA

A

Same as OA
Analgesics
NSAIDs
COX-2 inhibitors

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5
Q

When should DMAR be given

A

within 3months of symptoms

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6
Q

Gold standard DMAR

A

Methotrexate

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7
Q

What combination of DMARDs would you give to a newly diagnosed RA patient

A

Methotrexate
at least one other DMARD
Short term glucocorticoids

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8
Q

What would you give to a newly diagnosed RA patient who is pregnant

A

DMARD monotherapy

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9
Q

What would you do with this patient

Recent-onset RA and receiving combination DMARD and satisfactory control

A

Cautiously reduce dosage to a level that still controls the disease

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10
Q

How long before the benefit of methotrexate is seen?

A

3-12 weeks

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11
Q

How often do you give methotrexate

A

Orally
once a week
in the same day (start with a higher dose and then decrease it when controlled)

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12
Q

MoA of methotrexate

A

Folic Acid antagonist
Limits DNA and RNA synthesis
Inhibits dihydrofolate reductase and thymidylate synthetase
Blocks the production of pro inflammatory cytokines

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13
Q

Side effects of methotrexate

A

Can cause liver problems

Can affect blood count

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14
Q

What is sulfasalazine

A

Combination of sulfapyridine and salicylate with an azo bond

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15
Q

How is sulfasalazine absorbed

A

Not well absorbed across the gut (<15%)

so metabolised by gut bacteria into 5-ASA which is better absorbed

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16
Q

What is the MoA of sulfasalazine

A

Not well understood

some think treats local gut inflammation which causes a knock on effect to help with joint inflammation

17
Q

What else can sulfasalazine treat?

A

Ulcerative collitis

18
Q

What is hydroxychloroquine

A

Anti-malarial drug

19
Q

What is the MoA of hydroxychloroquine

A

Blocks toll like receptor 9
Decreases activation of dendritic cells
do not get interaction between dendritic and b cells

20
Q

What is the side effect of hydroxychloroquine

A

Rash

21
Q

What is leflunomide

A

Efficacy similar to methotrexate

Inhibits pyrimidine biosynthesis through inhibiting dihydroorate dehydrogenase to inhibit DNA and RNA synthesis

22
Q

Examples of TNFa blockers

A

Etanercept
Infliximab
Adalimumab

23
Q

Etanercept

A

Fusion protein human TNF receptor 2 and Fc human IgG1
Binds and stops TNFa from signalling
1-4 weeks for effect

24
Q

Infliximab

A

Monoclonal antibody against TNFa
Against the mouse binding site of TNFa with the remaining human 75% IgG1
Days to weeks for effect

25
Q

Adalimumab

A

Human TNFa monoclonal antibody

Binds TNFa both soluble

26
Q

Interleukin 1 blockers

A

Anakinra
Canakinumab
Rilonacept

27
Q

Anakinra

A

Human recombinant IL-1 receptor antagonist
Binds to IL-1R preventing IL-1 binding
Differs from IL-1 by addition of N-terminal methionine
(binds to IL-1R with same affinity as IL-1)
2-4 weeks to have an effect

28
Q

Canakinumab

A

Human monoclonal antibody
targets IL1-B
trials for COPD and gout

29
Q

Rilonacept

A

Dimeric fusion protein extracellular domain of IL1R1 and Fc human IgG1
Used more for acute gout

30
Q

B cell monoclonal antibodies

A

Used if unresponsive to anti-TNFa

Rituximab

31
Q

Rituximab

A

Chimeric monoclonal antibody against CD20 on the surface of B-cells
Destroys malignant and normal B-cells
effects after 3 months of infusions

32
Q

Abatacept

A

Fusion protein IgG fused to extracellular domain of CTLA-4

Prevents 2nd signal being delivered to T cell

33
Q

Betalacept

A

Anti-CD28, modulate T-cell signalling

34
Q

Tocilizumab

A

Human monoclonal antibody against IL-6 receptor

given in combo with methotrexate

35
Q

Neutralising Anti Drug Antibodies

A

directly interferes with the biological drugs ability to work

36
Q

Non-neutralising Anti Drug Antibodies

A

May form immune complexes around injection site reducing drug concentration and pharmacokinetics

37
Q

T CELL

A

Abatacept

Belatacept

LOCO (25 decks)

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