DMARDs Flashcards
What are the general features of DMARDs?
➢ Slow acting - weeks to months
➢ Pure anti-inflammatory with no direct analgesic effect
➢ Improve standard laboratory tests of inflammation e.g.ESR, CRP
➢ Reduce rate of joint damage
➢ Most need regular monitoring for adverse effects
Methotrexate:
- what is this
- how can this be used
- what conditions is this used in?
➢ Mode of action unknown ➢ Folate antagonist ➢ First choice DMARD in most patients ➢ Can be given orally or subcutaneously ➢ Often used in combination ➢ Used in RA, Psoriatic arthritis, Connective Tissue Disease and Vasculitis
What are the adverse effects of methotrexate?
➢ Leucopenia / thrombocytopenia
➢ Hepatitis / cirrhosis (alcohol intake must be limited)
➢ Pneumonitis (dont give in pulmonary fibrosis or existing lung conditions)
➢ Rash / mouth ulcers
➢ Nausea / diarrhoea (can give an injection to lessen this)
➢ Needs monitoring of FBC and LFTs
➢ Teratogenic. Must be stopped in males and females at least 3 months before conception
Sulphasalazine: when is this used?
-what is it?
➢ An azo ester of sulfapyridine and 5-aminosalicylic acid
➢ Mode of action unknown
➢ Often used in combination with methotrexate in early inflammatory arthritis
If methotrexate hasn’t worked or can’t be tolerated use this
What are the adverse effects of sulphasalazine?
➢ Nausea ➢ Rash / mouth ulcers ➢ Neutropenia ➢ Hepatitis ➢ Reversible oligozoospermia ➢ Monitoring of FBC and LFTs
When is hydroxychloroquine used?
➢ No effect on joint damage
➢ Used in connective tissue disease such as SLE (helps skin, joints and general malaise) Sjogren’s syndrome and RA
What is the adverse effects of hydroxychloroquine?
➢ Retinopathy - recognised but rare
This doesn’t suppress immune system so don’t use in psoriatic arthritis = flare up
What is the side effects of leflunomide?
hepatotoxicity
myelotoxicitiy
hypertension
What are the side effects of gold salts?
hypersensitivity reactions
nephritis
fibrosing alveolitis
what are the cautions of anti-TNF drugs?
➢ Major risk of infection (esp TB)
➢ Question over risk of malignancy (esp skin cancer)
➢ Contraindicated in certain situations e.g. pulmonary fibrosis, heart failure
Strict criteria for use:
➢ High disease activity score
➢ Use of previous standard DMARDs
What are the side effects of colchicine?
- diarrhoea and vomiting
- moderate doses
- can be given in a low dose for 6mths
What are the cautions of allopurinol
➢ Rapid reduction in uric acid level may result in exacerbation of gout - do not commence during acute attacks, always co-prescribe anti-inflammatory for first few weeks
Caution ➢ Rash (vasculitis) commoner in elderly and in renal impairment, therefore use lower doses ➢ Azathioprine interaction ➢ May inhibit warfarin metabolism ➢ Rarely marrow aplasia
When is febuzostat used? what are the cautions?
➢ Those who cannot tolerate allopurinol
➢ Renal impairment
➢ Used with caution in patents with ischaemic heart disease
Which antirheumatic drugs should be discontinued 3 mths before pregnanct?
methotrexate
Which antirheumatic drugs should be discontinuedwhen planning pregnancy and washout before pregnancy?
leflunomide
