Flashcards in Rheumatology Deck (31):
If you wish to use NSAID in a patient with osteoarthritis what can be done to guard against GI problems?
1. Add misoprostol
2. Add PPI or H2 blocker
3. Switch to Cox-2
Most common symptom in osteoarthritis?
-pain relief is the primary objective
What do NSAIDs and ASA affect?
1st line treatment for osteoarthritis
2nd line treatment for osteoarthritis
topical or oral NSAID
What are the uses/benefits of using Choline and magnesium trisalicylate?
strategy to reduce GI toxicity
Topical NSAID of choice in patient over 75
If patient is over 75 years old, what is the first line agent for hand osteoarthritis?
Oral NSAIDs, Topical NSAIDs
topical capsaicin +/- tramadol
If patient is over 75 with hand arthritis what is the 2nd line treatment
Combination: topical NSAID with tramadol
Goal of RA treatment
Achieve remission or low disease activity
When should disease modifying antirheumatic drugs be started in RA?
within the first 3 months of diagnosis
What function do NSAIDs and corticosteroids have on RA disease?
adjunctive therapy for symptom relief.
What can be done if one DMARD is not adequate?
1. combination of DMARDS (ex. methotrexate and plaquenil)
2. DMARD + biologic
Non biologic DMARDs
-Tofacitinib (kinase inhibitor)
-Rituximab (peripheral B cell depletion)
If triple drug therapy is needed, what does the ACR recommend?
Methotrexate + hydroxychloroquine + sulfasalazine
Early vs. established RA
early is <6 months
established is >6 months
Hematologic - thrombocytopenia (CBC)
Pulmonary fibrosis (Xray)
Hepatic - elevated AST, ALT
MOA: decreases lymphocyte proliferation
Contraindicated: pregnancy, liver disease
Toxicities: bone marrow toxicity
-NOT myelosuppressive (like leflunomide)
-Hepatic and renal toxicities
-Ocular** (visual changes decrease in night or peripheral vision)
-Prodrug cleaved in colon (2 active metabolites after passing through the liver)
-Elevated ALT, AST
-May turn skin yellow-orange color* (no clinical significance)
-Binds iron supplements decreasing absorption of sulfazalazine****
-Tetracycline antibiotic derivative
-Use in moderate to severe disease in pt. who has failed methotrexate
-Tyrosine kinase inhibitor
-No live vaccines if taking this medication**
infliximab, etanercept, adalimumab
ADE: MS-like illness, exacerbate MS
increased risk of lymphoproliferative cancer
Which biologic depletes peripheral b cells
-Chimeric antibody (human and mouse)
-Must be given with Methotrexate to prevent antibody formation
-human IgG antibody to TNF
-MOA: affects T-cell proliferation and activation
-Don't give live vaccines
-avoid live vaccines