Treatment Options for RA Flashcards
1
Q
What are DMARDs?
A
Disease modifying anti-rheumatic drugs
2
Q
What parts of the body does RA affect?
A
- joints
- tendon sheaths
- other body organs
3
Q
Why does RA affect body organs?
A
- affects any membrane with similar structure to synovium so serous membranes around heart/GI system are affected
4
Q
How is RA symmetrical?
A
- cytokine disease
- spreads from distal to proximal joints
- vertebral bodies damaged frequently as midline
5
Q
What are the 2 main methods of management?
A
- pain relief -> same guidelines as OA
- DMARDs to modify disease progression
6
Q
What is the gold standard DMARD?
A
Methotrexate
- cannot give in pregnancy
- start within 3 months of symptoms starting
- combined with other for mild RA
- combined with TNFa inhibitor for moderate
- combined with rituximab for severe
7
Q
What are some additional therapies?
A
- physiotherapy
- occupational therapy
- podiatry
- therapy (stress management, relaxation, coping)
8
Q
What is methotrexate? Mechanism of action
A
- folic acid antagonist
- enters the cell polyglutamated
- prevents production of DNA and RNA synthesis during cell mitosis by inhibiting dihydrofolate reductase and thymidylate synthase
- used in chemotherapy
- blocks production of pro-inflammatory cytokines
- stops production of additional synoviocytes
9
Q
What are the side effects of methotrexate?
A
- liver problems
- affects blood count
10
Q
What is the dosage for methotrexate?
A
- orally once a week on same day
- loading dose = 5-10mg a week
- maintenance dose = 2.5mg tablet
- if oral ineffective -> subcutaneous or IM injection
11
Q
What is sulfasalazine?
A
- DMARD
- old sulphur antibiotic
12
Q
What is the mechanism of action of sulfasalazine?
A
- not well understood
- not well absorbed across gut
- metabolised by gut bacteria to 5-ASA
- inhibits COX, cytokines, IL-1 and TNFa in gut modulating travel sites where they produce joint inflammation
13
Q
What is 5-ASA?
A
- metabolite of sulfasalazine
- treats ulcerative colitis and relieves arthritic symptoms
- role in the gut
14
Q
What is hydroxychloroquine?
A
- anti-malarial
- DMARD
15
Q
What is the mechanism of action of hydroxychloroquine?
A
- accumulates in lysosomes increasing pH -> decrease protein modifications of precursors which are secreted with cytokines
- block TLR9 decreasing dendritic cell activation which signal to B cells and lymphocytes
