Treatment Options for Rheumatoid Arthritis Flashcards Preview

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Flashcards in Treatment Options for Rheumatoid Arthritis Deck (30)
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1
Q

Outline the treatment pathway for rheumatoid arthritis.

A

Pain relief (analgesics, NSAIDs, COX-2 inhibitors) and then DMARDS (biological or non-biological)

2
Q

What regions are most commonly affected by rheumatoid arthritis?

A

Small joints of the hands and feet

3
Q

What is the difference in action of biologicals and non-biologicals in DMARDs?

A

Non-biologicals target the immune cells often by unknown mechanisms whereas biologicals target specific parts of the inflammatory cascade and are specific

4
Q

Name some examples of non-biological DMARDs

A

Gold, sulfasalazine, methotrexate

5
Q

Name some examples of biological DMARDs

A

Infliximab, adalimumab, rituximab

6
Q

What is the initial treatment given for rheumatoid arthritis

A

In newly diagnosed patients they are prescribed methotrexate and at least one other DMARD plus short-term glucocorticoids (steroids)

7
Q

What are the some of the issues associated with non-biological DMARDs?

A

Take a long time for them to start working

8
Q

What are the potential side-effects of methotrexate?

A

Liver problems, affect blood count, folic acid antagonist

9
Q

What is sulfasalazine?

A

This is a form of antibiotic that combined sulfapyridine and salicyclate with an azo bond that is used as a non-biological DMARD in the treatment of rheumatoid arthritis

10
Q

Why can’t methotrexate be given to pregnant women?

A

It is a folic acid antagonist and therefore increases the risk of neural tube defects

11
Q

How can hydroxychloroquine be used in the treatment of rheumatoid arthritis?

A

Antimalarial drug which accumulates in lysosomes to increase acidity and decrease protein modifications and block TLR-9 and decrease activation of dendritic cells.

12
Q

How can leflunomide be used to treat rheumatoid arthritis?

A

Mode of action is poorly understood but though tot inhibit pyrimidine biosynthesis by inhibiting dihydroorotate dehydrogenase to prevent DNA and RNA synthesis.

13
Q

How may azathioprine be used in the treatment of rheumatoid arthritis?

A

It’s a pro-drug consisting of 6-metcaptopurine and a purine synthesis inhibitor; it interferes with the synthesis of prints required for DNA synthesis. It can be used in combination with prednisolone to reduce the dose of steroid required.

14
Q

How may gold salts be used in the treatment of rheumatoid arthritis?

A

Mechanism is poorly understood but can have substantial side-effects and take a long time to work.

15
Q

Name three examples of TNFa inhibitors used in the treatment of rheumatoid arthritis

A

Etanercept, infliximab, adalimumab

16
Q

Name three IL-1 inhibitors used in the treatment of rheumatoid arthritis

A

Anakinra, canakinumab, rilonacept

17
Q

What targets are used for biological therapy for rheumatoid arthritis?

A

TNFa, IL-1, IL-6, B cells and T cells.

18
Q

Name an IL-6 inhibitor used in the treatment of rheumatoid arthritis

A

Tocilizumab

19
Q

Name a B cell inhibitor used in the treatment of rheumatoid arthritis

A

Rituximab

20
Q

Name a T cell inhibitor used in the treatment of rheumatoid arthritis

A

Abatacept

21
Q

Outline how etanercept works to treat rheumatoid arthritis

A

Combination of TNF receptor and Fc portion of human IgG1 which works to prevent TNFa from binding to it’s receptors and providing an inflammatory response

ESSENITALLY: antibody against TNFa

22
Q

Outline how infliximab works to treat rheumatoid arthritis

A

This is a monoclonal antibody against TNFa

23
Q

Outline how adalimumab works to treat rheumatoid arthritis

A

Human TNFa monoclonal antibody which can bind TNFa in soluble and insoluble forms to prevent binding to receptor

24
Q

Outline how anakinra works to treat rheumatoid arthritis

A

This is a recombinant IL-1 receptors which binds to IL-1 also to block the receptor so IL-1 can’t bind to have an effect

25
Q

Outline how canakinumab works to treat rheumatoid arthritis

A

Human monoclonal antibody which targets IL-1b to bind IL-1 before it gets to the receptor to work

26
Q

Outline how rilonacept works to treat rheumatoid arthritis

A

Binds to extracellular domain of IL-R1 receptor and the Fc portion of human IgG1 to bind IL-1 before it can act on the receptors.

27
Q

Outline how rituximab works to treat rheumatoid arthritis

A

Monoclonal antibody against CD20 receptor on B cells to destroy normal and malignant B cells.

28
Q

Outline how abatacept works to treat rheumatoid arthritis

A

A fusion protein of IgG and CTLA4 which has an affinity for the CD28 receptor on the T cells, which prevents the second signal from being delivered

29
Q

Outline how toclizumab works to treat rheumatoid arthritis

A

Monoclonal antibody against IL-6

30
Q

What condition, aside from rheumatoid arthritis, is rilonacept used to treat?

A

Acute gout