Msk Week 4 Objective 8

Front 1

Name the 6 DMARDS:

Back 1

Hydroxychloroquine
Methotrexate
Gold Salts
Sulfasalazine
Leflunomide
Cyclosporine

Front 2

Name the 6 biologic DMARDS:

Back 2

Etanercept
Infliximab
Adalimumab
Anakinra
Abatacepty
Rituximab

Front 3

Define the criteria for mild disease with respect to RA:

Back 3

• Elevations in ESR or serum C-reactive protein concentration
• at least 3 simultaneously inflamed joints
• Arthralgias
• No extra-articular disease
• Negative RF test
• No evidence of erosions or cartilage loss on plain radiographs

Front 4

Define the criteria moderate disease with respect to RA:

Back 4

Between 6 and 20 inflamed joints
Absence of extraarticular disease
Elevated ESR/CRP concentration
Positive RF
Evidence of inflammation via plain radiography such as osteopenia and periarticular swelling usually no erosions observed

Front 5

Define the criteria severe disease with respect to RA:

Back 5

• More than 20 persistently inflamed joints
• A rapidly declining functional capacity
• Elevated levels of ESR or CRP
• Anemia of chronic disease
• Hypoalbuminemia
• High titer of RF
Extra-articular diseases: rheumatoid nodules, eye or lung inflammation

Front 6

Outline the treatment protocol for mild RA:

Back 6

• Recent onset: (<6wks)
o NSAIDS at full dose
- naproxen
- ibuprofen
- diclofenac
Patients with history of peptic ulcer
• Selective Cox-2 Inhibitor
- celecoxib

Pain relieve and counsel for nonpharmcological treatments

Front 7

Outline the treatment protocol for moderate RA:

Back 7

• Start on NSAID and a DMARD (methotrexate the usual choice, except in women in child baring age)
• If remain active or NSAID toxicity:
- another NSAID and or intra-articular steroids
• Addition of Prednisone:
- usually for short period to treatment regimen while awaiting response to DMARD
If long term oral corticosteroids used ant-resorptive bone therapy needed (bisphosphonate)

Front 8

Outline the treatment protocol for severe RA:

Back 8

Goal: suppress synovitis
• NSAID full dose
• One of the more effective DMARDS such as methotrexate
• if MTX ineffective after 6-8 wks dose should be increased (stepwise)
• Addition of prednisone: or selectively inject several joints with DepoMedrol
Addition of further DMARDS: combo
- Methotrexate and hydroxycholoroquine
- Methotrexate, intramuscular gold, sulfasalazine (good for short term)
- Methotrexate is a drug that’s used long term

Front 9

What is the target for Abatacept therapy, and what cellular process does it interfere with?

Back 9

A B7-binding molecule, which inhibits the co-stimulatory signal required for RA pathogenesis.

Front 10

What are the four main classes of pharmalogical therapy for RA?

Back 10

1. Analgesics: acetaminophen, opiods
2. NSAID’s
3. Glucocorticoids
4. DMARDS

Front 11

What would you monitor in your patients that are on Methotrextae therapy for RA?

Back 11

Watch for:
-Myelosupression Sx: fever, infection, bruising, bleeding
-shortness of breath
-nausea/ vomiting
-lymph node swelling
Every 4-8 weeks:
-CBC, diff
-liver function test (AST, albumin)
-creatinine

Front 12

What is the benefit of prescribing Leflunomide over Methotrexate?

Back 12

Leflunomide does not cause pneumoitis.

Front 13

Define Methotrexate’s mechanism of action.

Back 13

Methotrexate is a chemotherapeutic agent that is a folic acid antagonist. It is structurally similar to folic acid and acts by reversibly inhibiting dihydrofolate reductase, the enzyme that reduces folic acid to tetrahydrofolic acid. This inhibition ultimately interferes with the synthesis of DNA and cell reproduction.

Front 14

List the types of non-pharmacologic therapy used in treating RA:

Back 14

-Nutrition
-Exercise
-Smoking cessation
-Rest: joints
-Physiotherapy
-Occupational Therapy:
-Prevention of Osteoporosis

Front 15

What is the benefit of DMARD therapy?

Back 15

Potentially can reduce or prevent joint damage, preserve joint integrity and function.

Front 16

What mechanisms of action does biologic DMRD therapy employ?

Back 16

-Anticytokine therapies
-Anti-tumor necrosis factor agents (anti-TNF)
 Etanercept, Adalimumab, Infliximab
-Interleukin 1 receptor antagonist (IL-1Ra)
 Anakinra
-Newest (2006)
 Abatacept:, Rituximab

Front 17

What is the general strategy in the pharmacological management of RA?

Back 17

Patients with established disease should be treated aggressively at the earliest point possible, this is based on the fact that destruction of diseased joints due to active inflammation occurs early on in the disease.