Flashcards in 5.1 Drugs in Arthritis - DMARDs for RA Deck (12)
What are the joints used for RA monitoring?
MCP, PIP, wrist, elbow, shoulder and knees
What is RA?
Autoimmune disease affecting multiple organ systems but mainly characterised by inflammation of the synovial membrane lining the joints causing joint damage from bone erosion, resulting in pain, stiffness and swelling
What are the 7 criteria for RA and what is the criteria for diagnosis?
Morning stiffness > 1 hour
Arthritis in 3 or more areas
Arthritis of hand joints
Serum rheumatoid factor (CCP as well)
Need at least 4 and the first 4 criteria must be present for 6 weeks
When is the bone erosion and joint damage greatest?
In the first 2 years
What are the indicators of poor prognosis of RA?
Younger age, disease duration, older at onset
Low education, poverty
Greater number of joints affected
Uncontrolled inflammation with high CRP and ESR
Nodules, vasculitis and other extra-articular disease
High titre RF
What is the treatment guidelines for RA?
Treat hard and treat early --> MTX
What is MTX?
Antimetabolite - it is a folic acid analogue which allows it to impair cell division, monocytic cell growth and induce apoptosis. Also has an anti-inflammatory effect at low doses
When should patients move to biologic DMARDs?
When there is high RF/ ACPA, high disease activity and early joint damage
What is the role of TNF in RA?
Mediates pathologic inflammation
Mediates joint destruction
Mediates systemic extra-articular symptoms of inflammation
What do you need to be careful of with bTNF inhibitors?
history of TB
pre-existing or recent onset malignancy or CNS demyelinating disease
Contraindicated in mod-severe heart failure
What are the goals of RA treatment?
Therapeutic remission with DMARDs
Minimise adverse effects of DMARDs
Modulate CV risks and other co-morbidities