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

Outline the treatment pathway for rheumatoid arthritis.

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

2

What regions are most commonly affected by rheumatoid arthritis?

Small joints of the hands and feet

3

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

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

4

Name some examples of non-biological DMARDs

Gold, sulfasalazine, methotrexate

5

Name some examples of biological DMARDs

Infliximab, adalimumab, rituximab

6

What is the initial treatment given for rheumatoid arthritis

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

7

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

Take a long time for them to start working

8

What are the potential side-effects of methotrexate?

Liver problems, affect blood count, folic acid antagonist

9

What is sulfasalazine?

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

Why can't methotrexate be given to pregnant women?

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

11

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

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

12

How can leflunomide be used to treat rheumatoid arthritis?

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

13

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

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

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

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

15

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

Etanercept, infliximab, adalimumab

16

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

Anakinra, canakinumab, rilonacept

17

What targets are used for biological therapy for rheumatoid arthritis?

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

18

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

Tocilizumab

19

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

Rituximab

20

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

Abatacept

21

Outline how etanercept works to treat rheumatoid arthritis

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

Outline how infliximab works to treat rheumatoid arthritis

This is a monoclonal antibody against TNFa

23

Outline how adalimumab works to treat rheumatoid arthritis

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

24

Outline how anakinra works to treat rheumatoid arthritis

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

Outline how canakinumab works to treat rheumatoid arthritis

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

26

Outline how rilonacept works to treat rheumatoid arthritis

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

Outline how rituximab works to treat rheumatoid arthritis

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

28

Outline how abatacept works to treat rheumatoid arthritis

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

Outline how toclizumab works to treat rheumatoid arthritis

Monoclonal antibody against IL-6

30

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

Acute gout