NSAIDs 2 - Rheumatoid arthritis Flashcards
(51 cards)
What population is mostly affected by Rheumatoid arthritis? What part of the body is usually affected?
It’s more common in women (3x)
Commonly affects small joints of the hand, wrists, and feet
Ankles, elbows, hips, knees, and shoulders may also be affected
What causes rheumatoid arthritis?
It’s an autoimmune response caused by activated T and B cells and activation of polymorphonuclear leukocytes
This leads to the release of inflammatory cytokines which leads to joint inflammation and destruction
What are DMARDs?
Disease-modifying antirheumatoid drugs
These are agents given to slow or halt damage and scarring with chronic inflammatory disease
How do DMARDs work?
They work by suppressing neutrophils, macrophages, and they act as immunosuppressants.
When do we use DMARDs?
After previous NSAIDs have been tried and they failed
Do DMARDs work right away?
No there is a latency period for effectiveness
Mechanism of action of gold salts?
Inhibits migration of macrophages into the synovial fluid
Inhibits phagocytic actions of macrophages
Inhibits cytotoxic effects of T-cells
Suppresses maturation and function of macrophages and T-cells
How long do gold salts take to work?
3-6 months
Adverse effects of gold salts?
Accumulation in skin and mucous membranes (15%)
Can cause rashes, skin discoloration (blue-grey)
Lesions of mucous membranes (mouth, GI, vaginitis)
Tubule damage in kidneys (5-10%)
Hematological problems (1-10%) - thrombocytopenia, aplastic anemia
How are gold salts administered?
Auranofin (oral)
Aurothioglucose/Gold sodium thiomalate (IM)
Are gold salts well tolerated?
15-35% discontinue therapy due to side effects
When do we use gold salts?
Always used AFTER NSAIDs have been tried, their use is limited
How do corticosteroids work in RA?
Pharmacological doses used to suppress immune system
They inhibit the formation of cytokines, including interleukins, TNF
When do we use corticosteroids?
Short term use usually (limited long term use)
Used for flair ups
How does methotrexate work in RA?
It decreases folic acid synthesis to inhibit DNA synthesis, which inhibits lymphocyte proliferation
How is methotrexate administered for RA?
Low doses
Oral or parenteral, once weekly
Takes 2-3 weeks to see effect
How long can pts be on methotrexate? Corticosteroids?
Short term corticosteroids
Methotrexate pts have been on for 5-7 years and it’s still working soo
Toxicities associated with methotrexate?
Nausea
Mucosal ulcers
Hepatotoxicity
When do we use Leucovorin?
As a MTX rescue
Use it 24 hours after methotrexate administration to rescue normal cells
What is Leflunamide?
Inhibitor of mononuclear and T cell proliferation
Inhibits immune cell DNA synthesis
When do we use Leflunamide?
It’s used as an alternative to methotrexate
Cautions with Leflunamide?
Hepatotoxicity
Bone marrow suppression
Absolutely contraindicated in pregnancy (Teratogenic)
Other side effects: Diarrhea, alopecia
How does Chlorambucil work?
It’s a nitrogen mustard, used to decrease DNA synthesis/formation of immune cells
How does Cyclophosphamide work?
It’s a nitrogen mustard, used to decrease DNA synthesis/formation of immune cells
