Clinical Aspects of Rheumatoid Arthritis

Question 1

What are the different treatment options for RA?

Answer 1

• Medicines
• Injections
• Therapies
• Surgery

Question 2

What are the different therapeutic categories for treatment of RA?

Answer 2

• NSAIDs
• Disease modifying anti rheumatic drugs (DMARD)
• Biologics
• Corticosteroids (oral, IM, IV)

Question 3

What does DMARD stand for?

Answer 3

Disease modifying anti-rheumatic drugs

Question 4

What are disease modifying anti rheumatic drugs (DMARD)?

Answer 4

• Group of structurally unrelated drugs that slow onset effect of disease activity and retard disease progression

Question 5

What are examples of DMARDs?

Answer 5

• Examples
  
  • Methotrexate
    
    • Effective and well tolerated
    • Cornerstone treatment of combination treatment (with DMARD and biologics)
  • Sulfasalazine
  • Hydroxychloroquine
  • Leflunomide

Question 6

What drug is the main treatment for RA?

Answer 6

• Methotrexate (a DMARD)

Question 7

How does the speed of action of biologics compare to DMARDs?

Answer 7

• In contrast to DMARDs they work quickly

Question 8

What are examples of different biologics?

Answer 8

• TNF-alpha inhibitors
• IL-1 inhibitors
• Anti B cell therapies
• Anti T cell therapies
• IL-6 inhibitors
• Oral kinase inhibitors

Question 9

What are some issues of biologics?

Answer 9

• Issues with toxicity as can be severe, such as injection
• Expensive

Question 10

How do biologics work?

Answer 10

• Targets key aspects of inflammatory cascade

Question 11

Should corticosteroids be used long term for RA?

Answer 11

Never (Balance of short term benefit vs long term toxicity)

Question 12

Summarise the approach to management of RA?

Answer 12

• Early and aggressive intervention key to obtaining optimal outcomes
• Effective suppression of inflammation improves symptoms and prevents joint damage and disability
• Usually use combination of therapies
  
  • Step up, step down and parallel