RA

Question 1

what is a tretament all patients with RA get?

Answer 1

methotrexate

Question 2

how often is MTX given?

Answer 2

once weekly

Question 3

what dosage forms of MTX exist and what should we use

Answer 3

oral, injection

starts with oral if GI prpbelms can try Im or SC

Question 4

What drug class is MTX?

Answer 4

DMARDs

Question 5

what are some other DMARDs

Answer 5

MTX, hydroxycholorquine (HCQ), sulfasalzine (SSZ)

Question 6

what happens if you develop an infection on a DMARD or biologic?

Answer 6

fever, infection or biologic given give us a call to see if we should hold RA meds as they increase risk of infection

Question 7

what is the use of prednisone in RA

Answer 7

to control flare up, can be used as a bridging therpy until DMARDs start to work

Question 8

what are the DMARD, therpay options

Answer 8

monotherpay: MTX
Dual therpay: MTX, HCQ,
Triple Therpay: MTX, HCQ, SSZ

Question 9

what are comon side effects of MTX?

Answer 9

nausea, fatigue, headche, sore mouth

Question 10

what shoukd we take in combination with MTX and why

Answer 10

folate acid as this can help alleviate side eefcts

Question 11

what are some rare side effects of MTX?

Answer 11

hepatic abnormalities, myelondoid suppresiion and CBC changes

Question 12

monitoring while on MTX

Answer 12

CBC and LFTs every 2 weeks for 3 months, then every 1-3 months

Question 13

prior to starting a biologic what should we have tried?

Answer 13

DMARD triple therpay for 3 months

Question 14

how long do DMARDS take to fully work?

Answer 14

3 months

Question 15

afater failing triple therpay what do we do?

Answer 15

try a biologic

Question 16

what is the first biologic recom

Answer 16

anti TNF- alpha

Question 17

what if anti-TNF alpha fails

Answer 17

try a different TNF - alpha or try another class

Question 18

what are some anti-TNF alpha agents?

Answer 18

Adalimumab
Etanercept
Certolizumab
Golimumab
Infliximab

Question 19

Il-^ receptor blocker agents

Answer 19

Tocilizumab

Question 20

T-Cell costimulation inhibt

Answer 20

Abatacept

Question 21

Il-1 recpetor antagonist

Answer 21

anakira

Question 22

B-Cell depletor

Answer 22

Rituximab

Question 23

when is JAB inhibiutor used

Answer 23

a step above other biologics

Question 24

for biologics what is the tolerability?

Answer 24

well tolerated

Question 25

what is the monitoring for biologics?

Answer 25

don’t require any bloodwork -can check the blood work every 3 months to see the inflammatory response (CRP), and ensure drug is working

once we know drug is working we can chcek blood work every 6 months

Question 26

What are the malignancy concerns? and with whihc medication? what can we use instead

Answer 26

anti-TNF- alpha may be aascoated with leukemia/lymphoma and thus with those with active cancer or history of cancer we avoid and use rituxmab

Question 27

at what stage should we use rituximab, why?

Answer 27

it is usualy last resort as it had cocnerning sideeffects such as infusion