Advanced Rheumatology

Aim of treatment

• Prevent long term problems and damage

• Symptom control

DAS 28 Score

Disease Activity Score - 28

Less than 2.1 = remission

3 months later

Active disease, DAS 28 6.0

What do you do?

Start a Biologic drug → eligible cause failed conventional DMARDs and DAS28 is over 5.1

DAS 28 - High disease state range

over 5.1

6 months later shes in remission with no side effects. Next steps

Check prognostic markers

• poor prognostic markers (high CRP and ESR) = more active disease = more aggressive disease

Tapering drugs and why?

Reducing number of doses, dose or number of drugs slowly

Taper because it reduces the side effects

Side effects of steroids

• osteoporosis

• diabetes

• weight gain

• cataracts

• pancreatitis

Tapering and Cessation of glucocorticoids

should be tapered as rapidly as clinically feasible

Main concern with NSAIDs

GI bleed

Do COX-2 inhibitors eliminate the risk of GI bleeds?

NO - only reduces

Cardiovascular risk associated with NSAIDs?

Increased risk of myocardial infarction and heart failure

Which NSAID had particularly high CV risk?

Rofecoxib

csDMARDs

Conventional synthetic DMARDs - methotrexate

What are TNF inhibitors?

Biologics that block TNF to reduce inflammation e.g.

• adalimumab

• etanercept

• infliximab

High relapse rates when stopped com[pared to continuation

What drug inhibits IL-6?

Toclizumab

What drug inhibits IL-1?

Ankinra

What are JAK inhibitors?

sDMARDs that block intracellular signalling

e.g. baricitinib, tofacitinib

What does Rituximab do?

Depletes B-cells

Can biologics be stopped in remission?

Sometimes, but relapse risk exists