Rheumatoid Arthritis Flashcards
(21 cards)
What is the 1st line in RA
Methotrexate - gold standard given within 3 months of diagnosis
what is the mode of action for methotrexate
- prodrug
- anti-inflammatory
- inhibits purine metabolism
- inhibits cytokine production and activation of immune cells like macrophages, T-cells and neutrophils
- inhibits DHFR
why does Methotrexate have a higher affinity to DHFR compared to dihydrofolate?
it has an additional hydrogen bond or iconic bonds which prevents the binding of FH2 and its conversion to N5, N10 methylene FH4
what drugs can you give in RA?
- Corticosteroids
- DMARDs - Methotrexate, Sulfasalazine, Hydroquinone, Leflunomide
- NSAIDs
- Paracetamols
- TCAs
- Biologics
what are Biologics?
comes from living organisms or living cells
- have large complex molecular structures
- expensive
- examples include Adalizumab, Certolizumab, etanecept, infliximab,
what biologic can be given instead of Methotrexate?
Adalizumab
Certolizumab
Etanecept
tocilizumab
what treatment do you give for severe active RA
Rituximab in combination with Methotrexate
what are the standards for the continuation of Rituximab + Methotrexate?
- there is an adequate response following initiation of therapy
- adequate response is maintained following retreatment with dosing interval of atleast 6 months.
- Adequate response = DAS28 of 1.2 points
Adalizumab, Etanecept, infliximab, certolixumab, golimumab, tocilizumab and abatacept, all in combination with methotrexate is allowed as options only if….
disease is severe - DAS28 of 5.1 AND
disease has not responded to intensive therapy AND
the companies that provide these drugs as agreed in their patient access scheme.
DMARDs and cDMARDs can be offered in combination?
yes
oral Methotrxate
leflunamide
sulfasalazine
hydroxyquinine
how are steroids given?
certain steroids can be given - Prednisolone, Methylprednisolone
- medium length course
oral prednisolone - starting 60mg/day gradually reduced to 7.6mg over 7 weeks.
Methylprednisolone - 120mg IM or on PRN basis
what is the mode of action for Hydroxychloroquine?
interferes with antigen presentation and activation of immune cells.
what is the mode of action for Sulfasalazine?
prodrug
gets broken down into Sulfapyridine and 5-aminosalysalate
metabolised by intestinal bacteria
has anti-inflammatory, immunosuppressive and Antibiotic action
can be used for RA, UC and CD
interactions - acetaminophen
what is the mode of action for Leflunomide
pyridine synthesis inhibitor
DMARDS
slows down structural damage associated with RA
what are the non pharmacological intervention for RA?
exercise
diet
psychological/Education
Stress reduction
surgical intervention
physiotherapy
what other organs does RA damage?
cardiovascular - inflammation in heart risk of pericarditis
lymphatic system - enlarged lymph nodes and spleen
joint inflammation tendonitis muscular pain
eye inflammation - uveitis
may cause Fever, weight loss
fatigue
rashes - salmon coloured, fleeting
Haematological complications
what does DAS show?
DAS28 - 5.1 = active disease
DAS28 <3.2 = low disease activity
DAS28 <2.6 = remission
3.2 - 5.1 = moderate RA activity
what tests are needed for diagnosis
serology test - C-reactive protein, ESR, RF, Anti-CCP
urea test - albumin decreased.
what are the clinical presentation?
often sets off as Fever, Malaise, arthralgia (pain in joints), Weakness before the progress to joint inflammation.
what are the common signs and symptoms?
persistent symmetric polyarthritis (synovitis) of HAND and FEETS
progressive articular deterioration
Difficulty in performing everyday tasks
it also affects the upper extremities - metacarpophalangeal joint, wrists, elbows, shoulders. lower extremities - ankles, feet, knees hips
what genes causes or are involved in RA?
HLA-DR1 and HLA-DR4 - increases the severity of and development
Red meat intake
coffee - too much
high salt intake
smoking
hormonal - disproportionate between female and male - prolactin
