Looks like no one added any tags here yet for you.
Rheumatoid Arthritis is…
chronic or acute
bilateral or asymmetrical
local or inflammatory
Rheumatoid Arthritis is
CHRONIC
BILATERAL/SYMMETRIC
INFLAMMATORY
RA is more common in what gender?
female
RA is typically caused by
genetic prediposition combined with a triggering event
2 risk factors for RA
family history/ genetic predisposition
low t levels in men
RA causes chronic inflammation of the synovial tissue lining the joint which leads to
erosion of bone (osteoporosis) and cartilage
Compared to Osteoarthritis, what is different about the joint stiffness that occurs in Rheumatoid Arthritis?
joint stiffness can last all day in RA, where with OA the joint stiffness typically lasts for 30 min in the morning
Signs and Symptoms of RA:
fatigue, weakness, fever, loss of appetite
tender/swollen joints, nodules, symmetrical joint involvement
Lab tests done on a patients with RA will show elevated…
ESRs and CRPs
What joints are primarily affected by RA? How is this different than OA?
small joints. OA usually affects larger joints.
In order to diagnosis RA, what is a mandatory requirement?
evidence of definite synovitis in at least one joint
Are RA treatments for controlling or curing the disease?
controlling
Nonpharm treatments of RA:
rest
therapy
assistive devices (cane, walker, etc)
weight loss
surgery
For low disease activity, what medication is recommended for initial therapy?
Hydroxychloroquine
For moderate-high disease activity, what DMARD is recommended for initial therapy?
Methotrexate
Guidelines prefer not bridging RA therapy with _____________ if possible.
Glucocorticoids
Bridging therapy may be needed for patients with
severe pain and inflammation
What is the only thing that can slow the progression of RA?
DMARDs
DMARDs stand:
Disease-Modifying Antirheumatic Drugs
For therapy with DMARDs, treatment should begin
as soon as possible, ideally within 3 months since symptoms start
How long does it take to see effects of therapy from DMARDs?
weeks to months
How are NSAIDs used in the treatment of RA?
bridging therapy, NOT AS MONOTHERAPY
Methotrexate belongs to what class of DMARDs
csDMARDs
Guidelines recommend methotrexate should be titrated to >___ mg per week.
15
ADRs of methotrexate
GI
Hematologic
pulmonary
hepatic
TERATOGENIC
What supplement should be taken with MTX?
folic acid
Contraindications of MTX
pregnancy
chronic liver disease
blood disorders (leukopenia, thrombocytopenia)
Immunodeficiency
Hydroxychloroquine main ADRs
RETINOPATHY
Leflunomide ADRs
Hepatic (elevated LFTs)
Hematologic (leukopenia, thrombocytopenia)
Teratogenic
Sulfasalazine is contraindicated in individuals that have a
sulfonamide or salicylate allergy
list the csDMARDs
Methotrexate
Hydroxychloroquine
Leflunomide
Sulfasalazine
Which is preferred over the other, csDMARDs or bDMARDs?
csDMARDs
bDMARDs are seperated what 2 classes
TNFI
non-TNFI
Names of the TNFi agents:
adalimumab
etanercept
golimumab
certolizumab
infliximab
Name the route all TNFi agents are administered, with the exception of infliximab.
SUB-Q
What is the route of Infliximab?
IV infusion
Name the frequency of administration for each TNFi agent:
adalimumab
etanercept
golimumab
certolizumab
infliximab
adalimumab- 1-2 weeks
etanercept- weekly
golimumab- monthly
certolizumab-monthly
infliximab- 8 weeks
TNFi agents should not be used in patients with
moderate-severe heart failure
ALL TNFi agents increase the risk of ___________ and _______________.
infection and malignancies
This specific TNFi agent has increased risk of infusion related reactions
infliximab
How do we prevent infusion related reactions?
premedicate w/ antihistamines, APAPs, Glucocorticoids
Name of non-TNFi agents
Abatacept
Tocilizumab
Rituximab
Sarilumab
Name the route and frequency for each non-TNFi agent:
Abatacept
Tocilizumab
Rituximab
Sarilumab
Abatacept- SUB-Q, weekly
Tocilizumab- SUB-Q; every 1-2 weekly OR IV; every 4 weeks
Rituximab- IV; every 24 weeks
Sarilumab- SUB-Q; every 2 weeks
Abatacept should be used with caution if you have
COPD
A non-TNFi is used when
csDMARDs and TNFi agents are ineffective
ALL non-TNFi agents increase the risk of
serious infections and malignancies
All tsDMARDs are what route?
oral
Names of tsDMARDs:
JAK Inhibitors
Tofacitinib
Upadacitinib
Baricitinib
What JAK Inhibitor/ tsDMARD increases the risk of CV morbidity/mortality?
Tofacitinib
What 2 bDMARDs have been shown to be safe to use throughout the entire pregnancy?
Etanercept and Certolizumab
To help reduce GI side effects of Methotrexate, what supplement should be taken?
FOLIC ACID