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19 Cards in this Set

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Why should every patient with established disease (RA) be treated aggressively from disease onset?
Because the destruction of affected joints due to active inflammation occures early in the course of the disease.
What are the 3 classes of treatment for RA?
1. Nonpharmacologic and preventative Tx.
2. Drug Tx.
3. Surgery
List some nonpharmacological treatments of RA.
1. Patient Education
2. Nutrition
3. Exercise
4. Smoking Cessation
5. Rest
6. Physiotherapy
7. Occupational Therapy
8. Osteoporosis prevention
When is surgery an option for the treatment of RA?
For those with functional abnormalities of specific joints caused by tendon rupture or by bone and joint destruction.
Drug therapy for RA is the mainstay of treatment for ALL patients except for...?
Those patients in clinical remission.
What are the goals of drug therapy in patients with RA?
Treating each patient sufficiently to induce a remission and preventing the further loss of joint function in daily activities.
What are the 4 main classes of drugs currently being used in the treatment of RA?
1. Analgesics
2. NSAIDs
3. Glucocorticoids
4. DMARDs (disease modifying antirheumatic drugs)
DMARDs can further be classified into 2 categories, name them.
1. Classical DMARDs
2. Biologic DMARDs
What are classical DMARDs, name a few.
A miscellaneous group of disease modifying drugs which have the potential to reduce or prevent joint damage, preserve joint integrity and function, reduce health costs, and maintain the functional level of the patient. ie. hydroxychloroquine, methotrexate, gold salts, sulfasalazine, leflunomide and cyclosporine.
What are biologic DMARDs, name a few.
They are anticytokine therapies.
ie.
1) Anti-TNF (etanercept, adalimumab, infliximab)
2) IL-1 receptor antagonist (anakinra)
3) Anti-CD20 (rituximab)
What is appropriate therapy for a patient with MILD RA of recent onset (less than 6 weeks)?
NSAIDs at full therapeutic dose (ie. naproxen, ibuprofen or diclofenac)
What is appropriate therapy for a patient with PERSISTENT MILD RA (more than 6 weeks)?
Physical and Occupational Therapy, with the addition of a DMARD. NSAIDs should be continued.

If the disease remains active, try changing the NSAID or an intraarticular injection of corticosteroids.
In patients with MODERATE RA what is the first line of treatment?
They should be started on a DMARD. Methotrexate is used quite often as the first line.
If the MODERATE RA disease persists, what is the next appropirate step in therapy?
The addition of prednisone.
Some rheumatologists will start out treatment for SEVERE RA with 'triple therapy', what drugs does this consist of?
A combination of 3 DMARDs, methotrexate, sulfasalazine and hydrochloroquine.
Which Tx is preferred, single therapy DMARD, or combination DMARD therapy?
Combination DMARD therapy is presently favored. Some common ones include:
1) Methotraxate (MTX), sulfasalazine & Hydroxychloroquine
2) MTX and gold
3) MTX and a biologic DMARD therapy
What are 2 downfalls of biologic DMARDs?
1) Very expensive ($1500-$3000 per month).
2) Long term effects are unknown.
In BC, when with the province cover the cost for these expensive biologic DMARDs?
For patients with severe RA who have not respsonded to adequate trials of at least 4 DMARDs including a combination DMARD.
RA has natural exacerbations (flares) and remissions. How should these 'flares' be treated?
By an increase in the dose of DMARD (if the pateint is on one) or a short course of oral corticosteroids.