Flashcards in RA Deck (48)
Loading flashcards...
1
Risk factors of RA
-Viral infection
-Birthweight greater than 10 lbs
-HLA DR4 allele
-Decaf coffee consumption
2
Factors that decrease risk of RA
-High Vit D intake
-OCPs
-Tea consumption
3
Systemic inflammation that occurs with RA
-Blood vessels
-Eyes
-Nerves
-Heart
-Skin
4
Misc effects of RA
-Decreased QOL
-Increased med costs
-Decreased employability
5
RA vs. OA
-Symmetrical (bilateral)
-Younger pts
6
Early vs. established RA classifications
Less than 6 months (early)
Over 6 months (established)
7
Low vs. moderate vs. high rheumatoid activity
Less than 6 joints (low)
6-20 joints (moderate)
Over 20 joints (high)
8
Poor prognosis factors of RA
-Persistent synovitis
-Early erosive disease
-Rheumatoid nodules
-HLA-DR4 alleles
-Fam hx
-High ESR and CRP
9
When should DMARDs be given in RA?
Within first 3 months of onset
10
Types of DMARDs
-Non biologic
-Biologic
11
When are nonbiologic DMARDs used in RA?
-Early disease w/low activity w/o poor prognosis (monotherapy)
-Early diseae w/HIGH activity w/o poor prognosis
-Established disease, low activity, w/o poor prognosis
12
MC used nonbiologic DMARD in RA?
MTX
13
MTX MOA in RA
-1st line
-Inhibits DNA synth, repair, cellular replication
-May affect immune function
-Unclear how exactly it works in RA
14
Key features of RA (dosing, onset, ADEs)
-Weekly dosing
-Onset in 3-6 wks
-Avoid ETOH and PPIs
-Can cause stomatitis, nausea, diarrhea, alopecia
-Preg Cat X
15
What can be taken to decrease the side effects of MTX?
Folic acid
16
What is Leflunomide (Arava)? MOA?
-Immunomodulatory pro-drug
-Usually 2nd line to MTX
-Inhibits pyrimidine synthesis (anti-proliferative and anti-inflammatory effects)
17
Leflunomide ADEs
-Diarrhea, alopecia, rash, HA
-Hepatotoxicity, PN, wt gain
-Maintain hydration
-Monitor BP
-Preg Cat X
18
When is Hydroxycholoroquine (Plaquenil) used in RA and MOA?
-Mild to mod w/o poor prognosis and for women of CBP
-Inhibits locomotion of neutrophils and chemotaxis of eosinophils
-Impairs complement-dependent antigen-antibody reactions
19
Features of hydroxycholoroquine (Plaquenil)
-Longer onset of action (8-12 wks)
-Eye exam every 3 months
-Rash, diarrhea, abdominal
-Blue/black skin discoloration
-Deafness, tinnitus
20
Sulfasalazine use in RA
-Can be monotherapy (MTX usually better choice)
-Inhibits PG synthesis
21
ADEs of sulfasalazine
-HA, nausea, dyspepsia
-Blue skin, sun sensitivity, jaundice
-Preg Cat B
22
How is minocycline used in RA?
-Unlabeled use
-Antimicrobial, immunomodulatory
-Potent inhibitor of metalloproteinates (which are active in RA joint destruction)
23
ADEs of minocycline
-Rash, HA, diarrhea
-Anorexia, tooth discoloration
-Avoid in pregnancy
24
Use of tofacitinib in RA
-2nd line to MTX
-JAK inhibitor (reduces inflammation)
-Should NOT be combined with a biologic
25
ADEs of tofacitinb
-TB
-Lowers blood counts
-Increases cholesterol and liver enzymes
-HA, diarrhea, infection, hepatic injury
26
Types of biologics used in RA
-Anti TNF biologics
-Non TNF biologics
27
When are biologics used in RA?
High disease activity w/poor prognosis
28
General warnings of biologics
Serious infections (including TB)
Malignancy
29
What is etanercept and its MOA?
-Self injection biologic for RA
-Binds w/circulating TNF inhibiting it
-No development of neutralizing antibodies
30
