Rheumatoid Arthitis

Question 1

What is rheumatoid arthritis?

Answer 1

Its a progressive autoimmune condition that affects the joints

Question 2

What are some clinical presentations of RA?

Answer 2

Symmetrical distribution, swelling, stiffness, fatigue, weakness, joint pain

Question 3

What are the 3 goals of RA therapy?

Answer 3

Relieve pain and inflammation, prevent joint destruction and preserve or improve ability and allowing the patient to maintain a normal lifestyle

Question 4

What are examples of sMARDs

Answer 4

Paracetamol, NSAIDs and Corticosteoids

Question 5

What is the MOA of methotrexate?

Answer 5

Its a folic acid antagonist and it inhibits dihydrofolate reductase.
In RA: It inhibits enzymes involved in purine metabolism, inhibits T cell activation, selective down-regulation of B cells and deactivation of enzyme activity to immune system function

Question 6

What are adverse effects of methotrexate?

Answer 6

GIT, hyperuricaemia, hepatotoxicity, myelosuppression and thrombocytopenia

Question 7

List examples of other DMARDs

Answer 7

Abatacept -modulates T-cell activation
Rituximab - beta cell monoclonal antibody
Adalimumab, Infliximab -TNF inhibitor

Question 8

What are the pharmacokinetics of methotrexate?

Answer 8

A - good oral absorption. Half life is 8-10 hrs.
D - also crosses into the muscles
E - mainly renally eliminated in the unchanged form.

Question 9

List 3 drug interactions of methotrexate.

Answer 9

Probenecid, other anti-folate drugs, allopurinol and live virus vaccines.

Question 10

What is the MOA of Leflunomide?

Answer 10

A potent dihydro-orotate dehydrogenase inhibitor and prevents the synthesis of purine ribonuleotide monophosphate pyrimidine (rUMP). Reduced rUMP activate p53 which restricts the progression of G1 to S phase of the cell cycle.

Question 11

What a common adverse effects of leflunomide?

Answer 11

Diarrhoea, N&V, Hepatotoxicity, Headache, Abdominal pain.