RHEUMATOID ARTHRITIS Flashcards Preview

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Flashcards in RHEUMATOID ARTHRITIS Deck (19):
1

RHEUMATOID ARTHRITIS OVERVIEW

-is an autoimmmune disese driven primarily by ACTIVATED T CELLS which give rise to cytokines

2

CLASSES OF DRUGS USED TO TREAT RA

1) NSAIDS: offer SYMPTOMATIC RELIEF, they reduce pain and inflammation

2) GLUCOCORTICOIDS:

--> ORAL corticoids relieve joint symptoms and control systemic manifestations, but their chronic use can cause many complications 

NOTE: BOTH NSAIDS AND GLUCOCORTICOIDS DO NOT PREVENT DISEASE PROGRESSION OR JOINT DESTRUCTION 

3) DMARDs: = Disease Modifying Anti-Rheumatic Drugs

-are a miscellaneous group of drugs with the potential to REDUCE/PREVENT JOINT DAMAGE

--> have no immediate analgesic effects, but can control symptoms and can DELAY/POSSIBLY STOP PROGRESSION OF THE DISEASE

-the effects of DMARDS may take 6 weeks - 6 months to become clinically evident

--> some biologics are effective within 2 weeks or less

3

METHOTREXATE

NON-BIOLOGIC DMARD

-generally the FIRST DMARD prescribed, is the FIRST CHOICE to treat RA

--> can be sued in mild, moderate, or severe RA

-doses of methotrexate required for RA are MUCH LOWER than those used in cancer chemotherapy

-adverse effects are minimized

4

BIOLOGIC DMARDS

are generally reserved for use in MODERATE-SEVERE DISEASE

5

LEFLUNOMIDE

NON-BIOLOGICAL DMARD

LEF-UNO-MIDE (left one of my) --> remember methotrexate... if it's not working the guy in the car will say oh i left one of my.... --> BOOM --> it works 

-seems to be AS effective as METHOTREXATE at reducing disease activity and progression

-patients who do not respond to methotrexate alone may benefit from COMBO THERAPY with leflunomide + methotrexate 

6

HYDROXYCHLOROQUINE

NON-BIOLOGICAL DMARD

-remember this is the "Queen" of the drugs so it takes 3-6 months to work, and she often needs help, doesn't work alone

-moderately effective for MILD RA

-usually well tolerated

-LEAST TOXIC of all DMARDs, and is the LEAST EFFECTIVE as monotherapy

-often used with other drugs, paricualry METHOTREXATE + SULFASALAZINE

-may require 3-6 months to show clinical benefits 

7

SULFASALAZINE

NON-BIOLOGICAL DMARD

-is effective in RA

-beneficial effects typically require 2-3 months to become apparent 

 

8

CYCLOSPORINE

NON-BIOLOGICAL DMARD

-can be helpful in some patients with RA

-NEPHROTOXICITY and many interactions with drugs and foods have limited its use 

9

AZATHIOPRINE

 

NON-BIOLOGICAL DMARD

-used for patients with REFRACTORY RA

 

10

CYCLOPHOSPHAMIDE

NON-BIOLOGICAL DMARD

CycloPHOSPHAMIDE --> does whole thing!!!! (is not just a sporin, sporin is borin)

-is generally limited to the MOST SEVERE CASES of RA

-long-term use increases risk of infection and malignancy 

 

11

ANTI-TNF DRUGS

BIOLOGICAL DMARD: ANTI-TNF

AEI (first 3 vowels) = 3 anti-tnf's 

1) ADALIMUMAB 2) INFLIXIMAB 3) ETANERCEPT

TNF-α effects are mediated by specific membrane-bound TNF receptors (TNFR1, TNFR2).

TNF-α is particularly important in the inflammatory process of rheumatoid arthritis.

TNF inhibitors act more quickly than nonbiologic DMARDs.

Use of TNF inhibitors in combination with methotrexate has synergistic beneficial effects.

12

RITUXIMAB

BIOLOGICAL DMARD

-commonly given concurrently with methotrexate or other non-biologic DMARDs

13

ABETACEPT

BIOLOGICAL DMARD

-effective in some patients who DID NOT RESPOND to non-biologic DMARDs or anti-TNF agents

--> is a BETA trial, might as well try it if other things aren't working

14

ANAKINRA

BIOLOGICAL DMARD

 

-approved for moderate to severe RA

-is MODESTLY EFFECTIVE

15

GLUCOCORTICOIDS

-short courses of low-dose corticosteroids can be given for symptomatic relief until the beneficial effects of DMARDS become apparent 

-intra-articular injection of a corticosteroid can often relieve an ACUTELY-INFLAMED RA joint with MINIMAL adverse effects

16

NSAIDS

have IMMEDIATE ANALGESIC and ANTIINFLAMMATORY EFFECTS

-are used mainly as BRIDGE DRUGS for RELIEF OF SYMPTOMS 

17

CHOICE OF DRUGS FOR RA

-for INITIAL TREATMENT: most clinicians prescribe a NON-BIOLOGICAL DMARD plus an NSAID or a corticoid to control symptoms 

-***methotrexate*** is generally the DMARD of choice 

MILDEST CASES: can use HYDROXYCHLOROQUINE + SULFASALAZINE 

MODERATE TO SEVERE: combining a biologic DMARD with a non-biolgoic DMARD for initial treatment may provide better disease control than a DMARD alone 

--> TNF inhibitors are the first-line biologic agnets prescribed 

 

18

COMBINATION THERAPY

-combination DMARD therapy may be more effective than monotherapy w/o a significant increase in toxicity 

-combination therapy typically includes weekly methotrexate, to which other agents are added

--> Hydroxychloroquine has LITTLE TOXICITY and is often used with other durgs, particularly methotrexate and sulfasalazine 

LEFLUNOMIDE in combo with methotrexate INCREASES RISK of HEPATOTOXICITY so patients must be monitored closely

Note: COMBO OF DIFF BIOLOGIC AGENTS increases risk of infection and is not recommended 

19

COMBINATION THERAPIES SHOWN TO BE EFFECTIVE

Combination therapies that have been shown to be effective include:

Methotrexate + HYDROXYCHOROQUINE

Methotrexate + SULFASALAZINE

Methotrexate + HYDROXYCHLOROQUINE + SULFASALAZINE

Methotrexate + CYLOSPORINE

Methotrexate + LEFLUNOMIDE

Methotrexate + TNF INHIBITOR