Osteoarthritis and Rheumatoid Arthritis

Question 1

Difference between Bouchards and Herberdens Nodes

Answer 1

Bouchards - PIP joints

Herberdens- DIP joints

Question 2

What are typical first line options for pain due Osteoarthritis?

What is this medication fails?

Answer 2

Acetaminophen

Topical or oral NSAIDS

Question 3

What is the primary goal when treating Osteoarthritis?

Answer 3

Pain relief

Question 4

What are contraindications of NSAIDS

Answer 4

Liver failure

Renal failure

Question 5

What are some monitoring parameters of NSAIDS?

Answer 5

complete blood count
serum creatinine
hepatic transaminase levels

Question 6

What are toxicities associated with NSAIDS

Answer 6

GI toxicity

Cardiovascular risk

Question 7

When is topical NSAIDS recommended vs oral?

What topical is preferred

Answer 7

Recommended for patients older than 75 years to decrease the risks of systemic toxicity

Ketoprofen most common

Question 8

How is Rheumatoid Arthritis defined?

Answer 8

Most common systemic inflammatory disease characterized by symmetrical joint involvement

Question 9

What is the Goal of treatment for RA

Answer 9

Achieve remission or low disease activity referred to as “Treat to Target”

Question 10

What are complications that can occur with Rheumatoid arthritis?

Answer 10

Marked ulnar deviation,
swan-neck deformity,
active synovitis,
nodules.

Question 11

What are first line treatment options for RA?

Answer 11

Disease-modifying antirheumatic drugs (DMARDs) or biologic agents within the first 3 months diagnosis

Question 12

What are first line treatment options for RA?

Which drug is most preferred?

Answer 12

Disease-modifying antirheumatic drugs (DMARDs)

Methotrexate

Question 13

What treatment options can you use if one DMARDS doesn’t work?

Answer 13

Combo therapy with 2 DMARDS OR

DMARD plus biologic agent

Question 14

What are the non-biological DMARD?

Answer 14

Methotrexate
Leflunomide
Hydroxychloroquine
Sulfasalazine
Minocycline
Tofacitinib

Question 15

MOA of Methotrexate

Answer 15

Inhibits cytokine production,
inhibits purine biosynthesis,
and may stimulate release of adenosine–leads to its antiinflammatory properties

Question 16

Which nutrient does Methotrexate block the production of?

Answer 16

Folic acid antagonist—leading to deficiency

Question 17

Contraindications for Methotrexate?

Answer 17

Pregnancy-teratogenic and nursing women
Chronic liver disease
Immunodeficiency
Pleural or peritoneal effusions
Leukopenia, thrombocytopenia,
CrCl <40ml/min

Question 18

What are toxicities of Methotrexate

Answer 18

Stomatitis—may see first (sores in the mouth)
hematologic-thrombocytopenia
pulmonary fibrosis and pneumonitis
hepatic-elevated liver enzymes

Question 19

What should be monitored when taking Methotrexate

Answer 19

CBC
LFT
CXR

Question 20

What is the MOA of non-biological Leflunomide?

Answer 20

inhibits pyrimidine synthesis–> decrease in lymphocyte proliferation and modulation of inflammation

Question 21

Toxicities of Leflunomide?

Answer 21

GI, hair loss, liver, bone marrow toxicity

Question 22

Contraindications fo Leflunomide?

Answer 22

liver disease

teratogenic

Question 23

What is the MOA of Hydroxychloroquine

Answer 23

dampen antigen–antibody reactions at sites of inflammation

Question 24

Toxicities of Hydroxychloroquine?

Answer 24

Lacks myelosuppressive -
Hepatic and renal toxicities
GI-N/V/D—take with food
Ocular-Visual changes including a decrease in night or peripheral vision

Question 25

What is the MOA of non-biologic Sulfasalazine

Answer 25

slide 45

Question 26

What are ADE of Sulfasalazine that may want you to decease the drug dose

Answer 26

Elevated hepatic enzymes May turn skin to a yellow-orange color—no clinical consequence Absorption can be decreased when antibiotics destroy colonic bacteria Binds iron supplements—decrease sulfazalazine absorption Can potentiate warfarin’s effects-displace from protein binding

Question 27

What is Minocycline a derivative of? What is it's MOA?

Answer 27

Tetracylcine inhibit metalloproteinases active in damaging articular cartilage

Question 28

What is the MOA of Tofacitinib

Answer 28

inhibition of JAK- a tyrosine kinase--modulation and suppression of the immune system through cytokine signal reduction

Question 29

When is Tofacitinib used?

Answer 29

moderate to severe RA who have failed or intolerance to methotrexate

Question 30

What are ADE of Tofacitinib?

Answer 30

serious infections lymphomas, and other malignancies tested and treated for latent tuberculosis elevated plasma liver enzymes and lipids live vaccinations should not be given during treatment

Question 31

Definition of Biologic agents that treat RA?

Answer 31

Genetically engineered protein molecules block the pro-inflammatory cytokines

Question 32

What are the TNF-alpha drugs?

Answer 32

``` Infliximab, entanercept, adalimumab, golimumab, certolizumab ```

Question 33

IL-1 drug? IL-6 drug?

Answer 33

IL-1: anakinra IL-6: tocilizumab

Question 34

MOA of TNF-alpha drugs? Contraindications? ADE?

Answer 34

Block the proinflammatory cytokins TNF-α Contraindications CHF ADEs MS-like illness or exacerbate MS Increased risk of lymphoproliferative cancer

Question 35

MOA of IL-1 Anakinra?

Answer 35

binds to CD80/CD86 receptors on antigen-presenting cells inhibits interactions between the antigen-presenting cells and T cells prevents T-cell activation to promote the inflammatory process

Question 36

What should not be given when taking Anakinra?

Answer 36

Live vaccines should not be given to patients during treatment with Anakinra therapy

Question 37

MOA of IL-6 Tocilizumab?

Answer 37

Attaches to IL-6 receptors preventing the cytokine from interacting with the IL-6 receptors

Question 38

ADE of Tocilizumab?

Answer 38

``` Increased infection risk Elevated plasma lipids Elevated liver enzymes Risk of Gastrointestinal perforation Inducer of CYP450 3A4 (warfarin) ```

Question 39

What should be avoided when taking Tocilizumab?

Answer 39

Tested and treated for latent tuberculosis | Live vaccinations should not be given during treatment

Question 40

What should be avoided when taking Tocilizumab?

Answer 40

Tested and treated for latent tuberculosis | Live vaccinations should not be given during treatment

Question 41

What is the MOA of biologic DMARD Riuximab? What should be avoided when taking this?

Answer 41

Binds to B cells nearly complete depletion of peripheral B cells No live vaccines while in treatment

Question 42

What is the MOA of biologic DMARD Abatacept?

Answer 42

Binds to CD80/86 on T cells to prevent the costimulation needed to fully activate T cells

Question 43

What are ADE of Abatacept?

Answer 43

HA, nasopharyngitis, dizziness, cough, back pain, HTN, dyspepsia, UTI, rash, extremity pain

Question 44

What should be avoided with Abatacept?

Answer 44

No live vaccines during treatment or for 3 months after completion of therapy