5.1 Drugs in Arthritis - DMARDs for RA Flashcards Preview

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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
Symmetric involvement
Rheumatoid nodules
Serum rheumatoid factor (CCP as well)
Radiographic changes

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
Structural damage/deformity
Nodules, vasculitis and other extra-articular disease
anti-CCP positive
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


What are the treatment options if MTX fails

Increase MTX dose
Add in corticosteroids
Add in hydroxychloroquine

Try drug with different action: Leflunomide, sulfasalazine
Add biologic DMARD is target not reached and poor prognostic factors