Rheumatoid Arthritis

Question 1

Poor prognosis Disease Features

Answer 1

• Smoking history
• Raised ESR
• Boney erosions evident on x-ray early in disease
• +’ve Anti-CCO
• High RF titre
• Functional impairment early in disease
• Swelling in more than 20 joints.

Question 2

Methotrexate Education Points

Answer 2

• Recommend abstaining from alcohol intake as hepatotoxic
• Contraindicated in pregnancy and will need to be ceased 3 months prior to attempting to fall pregnant.
• Will interact with folate antagonists such as trimethoprim
• Ensure 5-10mg/week of folic acid supplementation
• Regular monitoring of Liver function and kidney function and for anaemia with monthly FBC/EUC/LFT
• Will need vaccination as per immunosuppressed individual (pneumococcal and influenza immunisations)
• Live vaccines are contraindicated in the immunocompromised. Will need vaccines 4 weeks prior to starting therapy.
• Initial Review with FBC, Aminotransferases, Albumin, Creatinine Monthly for the first 3 months after initiating or increasing dose.

Question 3

Treatment for RA

Answer 3

csDMARDS
- Methotrexate 10mg PO Weekly + Folic acid 5mg PO Weekly
- Leflunomide 10mg PO OD
- Sulfasalaxine 500mg PO BD
- Hydroxychloroquine 200mg PO OD

Corticosteroids
- Prednisolone 5-15mg PO OD

biologicalDMARDS
- E.g. Infliximab / Etanercept