Rheumatic Disorders and RA Therapeutics Flashcards Preview

MED: Ortho/Rheum > Rheumatic Disorders and RA Therapeutics > Flashcards

Flashcards in Rheumatic Disorders and RA Therapeutics Deck (18):
1

What is RA?

An autoimmune disorder, rheumatoid arthritis occurs when your immune system mistakenly attacks your own body's tissues. A systemic autoimmune disease of unknown cause with its primary manifestation in synovial tissues. Synovial tissues proliferate in an uncontrolled fashion resulting in stretching of tendon and ligaments and erosions of bone.

2

Who does RA affect the most?

usually women
peak onset is 40's to 50's for women
and is 60's-80's for men

3

What are the symptoms of RA?

- insidious onset with MORNING STIFFNESS and PAIN
- systemic, symmetrical polyarthritis of small joints
- synovial cysts
- Rheumatoid nodules --> common on olecranon
- other complications: interstitial lung disease, pericarditis, vasculitis

4

What lab results will you find in RA?

1. anti-ccp
2. rheumatoid factor
3. ESR and CRP will be elevated

5

how long must you have symptoms to be diagnosed with RA?

more than 6 weeks.

6

What joints does RA affect?

1. cervical spine
2. MCPs and PIPs of hands and feet
3. wrist
4. shoulders
5. elbows
6. SI
7. knee
8. ankles

7

with RA, when will the stiffness improve?

after movement

8

Will RA show diagnostic changes on X-ray?

usually normal in first 6 months
then, changes are seen and are specific for RA

9

describe the treatment for RA?

go hard first with treatment.
1. DMARDS--> first line
2. Corticosteroids--> can be used for immediate relief before DMARDs take effect
3. NSAIDs

10

What are the steroid guidelines for RA?

prednisone 10 mg/day
- avoid using steroids without DMARDs
- use them as a bridge to therapy of DMARDs

11

What two types of DMARDs are there?

1. conventional
2. biologics

12

Describe methotrexate:

Widely used for RA since early 1980’s
Response Time: 1-2 months
Effectiveness: 80% +, long-term responses
Dose: 7.5mg to 25 mg/week (single dose) PO, SQ, IM
Toxicity: Mouth sores, N&V, liver, cytopenias, and pneumonitis (rare)
Monitoring: CBC, Albumin and ALT q 4-12 weeks
ONCE WEEKLY DOSE, GIVE WITH FOLIC ACID
*** be aware of pneumonitis

13

Describe hydroxychloroquine:

The easiest DMARD to take and monitor
Response Time: 2 - 3 months
Effectiveness: 60%
Dose: 200 – 400 mg q day po
Toxicity: Retinal (rare), CNS, GI
Monitoring: Eye check up yearly
Caveat: PREVENTS Diabetes in RA patients
Safest to take
Eye checks initially and then yearly after 5 years of treatment*

14

Describe sulfasalazine:

Response Time: 2-4 months
Effectiveness: 60 –70%
Dose: 1 – 3 grams q day
Toxicity: GI, neutropenia (rare), Liver (rare)
Monitoring: early monthly CBC, then similar to MTX
Caveat: Enteric coated tabs much better tolerated

15

Describe minocycline:

Response Time: 2-4 months
Effectiveness: 60 –70%
Dose: 1 – 3 grams q day
Toxicity: GI, neutropenia (rare), Liver (rare)
Monitoring: early monthly CBC, then similar to MTX
Caveat: Enteric coated tabs much better tolerated


Immunological
Promotes increased production of IL-10
Induces Lupus in some acne patients
Metalloproteinase Inhibition
Strong evidence in animal models of inflammatory and OA
Large NIH trial in process
Antibacterial
Not treating “the infectious cause of RA”
Treating non- specific activators of inflammatory response

16

What is the DMARD combo therapy?

Methotrexate-Hydroxychloroquine
Methotrexate-Sulfasalazine-Hydroxychloroquine
Methotrexate - Biologicals

17

What are the examples of biologic DMARDs:

TNF Inhibitors:
Etanercept (Enbrel)
Infliximab (Remicade
Adalimumab (Humira)
Certolizumab (Cimzia)
Golimumab (Simponi)

18

What do we need to be aware of with biologics and infections?

Always Screen for Tb and Hep B--> PPD
Beware of infections – especially opportunistic or skin
Stop biological if infection occurs
Pursue aggressive diagnostic work-up
Exacerbations of CHF, Multiple Sclerosis and Progressive Multifocal Leukoencephlopathy concerns
Always immunize before starting if possible and avoid live vaccines
Most work best with Mtx , especially anti-TNFs
Concerns for malignancy: Skin cancers and early in treatment course - lymphomas