Rheumatoid Arthritis Flashcards
(22 cards)
Increased risk of mortality
Condition associated
In CVD patients
Clinical Features
Deformities caused by inflammation
Swollen wrist joints
Cervical instability - spine
Pain management
Options
Paracetamol +/- weak opioids - can give adequate pain relief but not usually given
NSAIDs and COX2 specific inhibitors - most appropriate however it has a high toxicity profile due to S/E
Pain Management: COX2 inhibtors
Examples
Eterocoxib - given for patients with past ulcers and no CVD
Celecoxib
Give with PPI
Pain Management: NSAIDs
Examples
Naproxen - safe for CVD but intermediate GI risk
Ibuprofen - increase CVD and lowest GI risk
Give with PPI
Not given with asthmatic people
Corticosteroids
What is it for, given with and reason, med of choice
Rapid anti-inflammatory effect
For flares of RA
Given with DMARD (disease modification) or for bridging (until DMARD takes effect)
Prednisolone 7.5mg
Disease modifying anti-rheumatoid drugs (DMARDS)
When to use, examples
Use early (3-6 months) in disease onset to prevent irreversible effects of long-term joint inflammation
Methotrexate
Sulfasalazine
Leflunomide
Hydroxychloroquine
DMARDs: Methotrexate
Dose, S/E, monitoring, what to give with it and avoid
1st line
Dose - 7.5mg weekly, max 20mg
Monitoring - FBC, renal and LFTs
S/E - folic acid depletion, GI
Give Folic Acid - 5mg every week (24 hrs after Methotrexate)
Avoid aspirin and NSAID
DMARDs: Sulfasalazine
S/E
S/E - rashes, GIT, haematological abnormalities e.g. neutropenia, leucopenia etc
Dose - 500mg
Monitoring - FBC, LFTs
DMARDs: Leflunomide
Given for, essential, S/E, monitoring
Given if Methotrexate and Sulfasalazine are not suitable
Need a wash up period - as it stays in the body longer
Effective contraception is essential
S/E - bone-marrow toxicity, hepatotoxicity, risk of infection due to immunosuppressive effects
Monitor - FBC, LFT, BP, cholesterol due to CVD risk
DMARDs: Hydroxychloroquine
Monitorig, given for
Lowest toxicity - causes ocular toxicity (retinopathy)
Monitor - FBC, U&E’s, LFTs, eye sight
Given for women wanting to get pregnant
Other drugs that can be used (AGOCC)
Azathioprine
Gold
Pencillamine
Ciclosporin
Cyclophosphamide
Combination Therapy
Metho + Sulfa
Metho + Sulfa + Hydro
New strategy - Metho + another DMARD + corticosteroids
DAS28
Measures RA disease activity
DAS - disease activity score; 28 - number of joints
Calculating - number of tender and swollen joints + ESR + general health or global disease activity
TNF inhibitors: bDMARDs
Examples, when to give
Adalimumab, Etanercept, Infliximab
Rituximab - causes B lymphocytes lysis, avoid
Given if monotherapy or combintation therapy with DMARDs are not enough
JAK inhibitors
Examples, when to give
Baricitinib
Torcitinib
Upadacitinib
Folgitinib
Given if monotherapy or combination therapy is not enough
European League Against Rheumatism Criteria (EULAR)
What is it for
Takes into account any physical, psychological, sensory or learning or communication difficulties that affect DAS28 responses
Moderate to Severe DAS28 3.2 to 5.1: JAK inhibitors (UF)
Examples, given when, when to continue
Upadacitinib or Filgotinib - given with Methotrexate
Given if intensive therapy with 2 or more cDMARDs are inadequate
Continue treatment if there is a moderate response from EULAR - stop if it doesn’t
Moderate to Severe DAS28 3.2 to 5.1: bDMARDs (AEI)
Examples, given when, when to continue
Adalimumab, Etanercept, Infliximab - given with Methotrexate
Given if intensive therapy with 2 or more cDMARDs are inadequate
Continue treatment if there is a moderate response from EULAR = stop if it doesn’t
Severe DAS28 more than 5.1: JAK inhibitors
Examples, when to give
Baricitinib or Tofacitinib; Upadacitinib or Filgotinib - given with Methotrexate
Given to inadequate response to intensive therapy with a combination of cDMARDs
Severe DAS28 more than 5.1: bDMARDs
Adalimumab, Etanercept, Infliximab, Golimu,ab, Tocilizumab etc
Given with Methotrexate
Given if there is a moderate response from EULAR - stop if it doesn’t
Rituximab
Given with Methotrexate
Severe RA and has inadequate response to other DMARDs including TNF inhibitors
