Autoimmunity and Neoplasia: Agents Used for Arthritis

nearly ____ of americans have some form of arthritis

1/4

which is the most common kind of arthritis that is due to wear and tear

osteoarthritis

how many people in the US are affected by OA

over 32.5 million adults

who is more affected by OA

more women than men

which kind of arthritis is mediated by T and B cells, but mostly B cells

rheumatoid arthritis

how many people in the US are affected by RA

1.5 million people

who is more affected by RA

women 3x more than men; all ages

which kind of arthritis is mediated by T and B cells, but mostly T cells

psoriatic arthritis (PsA)

who is more affected by PsA

equally women and men

how many people in the US are affected by PsA

7.5 million americans

what is the kind of arthritis caused by monosodium urate deposition

gout

who is more affected by gout

men affected 3x more than women

how many people in the US are affected by gout

>9 million adults

what are 3 non-pharmacologic treatments for arthritis

1) exercise

2) weight loss

3) education

what does exercise help with in arthritis patients

decreased pain, decreased hospitalizations, increased functioning, increased QOL

what does weight loss help with in arthritis patients

decreased pain, increased functioning, increased QOL

how does education help arthritis patients

improves belief in capabilities

what are the 4 first line treatments for OA (strongly recommended)

1) exercise, weight loss, education

2) topical pain relievers

3) oral NSAIDs

4) intra-articular corticosteroids

give examples of topical pain relievers and when to use it

diclofenac gel; use only if a few affected joints such as knee

give examples of oral NSAIDS and when to use it

ibuprofen, naproxen; use celecoxib + proton pump inhibitor if pt has GI ulcer or reflux hx; used to treat flares in hand, hip, knees joints

what are the second line treatments for OA (conditionally recommended)

1) oral pain relievers such as acetaminophen

2) duloxetine (used for knee)

what are 2 things to consider about patients with OA and dentistry

1) patients taking NSAIDs will take longer to clot

2) should consider the amount of acetaminophen the patient may be taking for OA when recommending agents for dental pain

what are DMARDs

disease-modifying anti-rheumatic drugs

what are the 2 subtypes of DMARDs

synthetic and biological

what are synthetic DMARDs

small chemical molecules given orally

what is are examples of synthetic DMARDs

methotrexate, tofacitiNIB, baricitiNIB, upadacitiNIB

what are the main ADRs of synthetic DMARDs

nausea, diarrhea

what is the target of synthetic DMARDs

block janus kinase (-nib drugs often target kinase enzymes or intracellular pathways)

what are biological DMARDs

proteins administered subcutaneously or intravenously that block a specific immune system target

what are examples of biological DMARDs

infliximab, adalimumab, certolizumab, etc

what are the main ADRs of biological DMARDs

infections

what is the target of biological DMARDs

inhibit TNF (-mab drugs are monoclonal antibodies that target extra cellular or cell-surface molecules)

what other 2 things can biological DMARDs cause

1) inhibits production of IL-1 and IL-6 (pro inflammatories)

2) causes B cell lysis and depletion

what is strongly recommended as treatment for RA besides exercise, weight loss, and education

weekly oral methotrexate as monotherapy

when would you continue to conditionally recommended treatments for RA

when there is inadequate initial treatment response

what can you do for conditionally recommended treatments for RA

add JAK inhibitor or biological DMARD

what should you avoid when treating RA

avoid use of systemic glucocorticoids

which 3 other autoimmune conditions are sometimes treated with DMARDs

1) psoriasis or psoriatic arthritis

2) systemic lupus erythematosus

3) inflammatory bowel disease

which autoimmune condition is NOT typically treated with DMARDs

type 1 diabetes

why might patients with RA require more frequent dental care

incidence of caries, periodontitis, pulpitis and oral ulcerations may be higher in RA patients

what are 4 considerations dentists must be aware of in regards to DMARDs

1) some DMARDs will have DDIs with drugs used in dentistry

2) patients taking DMARDs will be at high risk for infection

3) patients taking DMARDs may not tell their dentist about therapies

4) RA can manifest in the TMJ

what are the strongly recommended preventions for gout

lifestyle management + urate lowering therapy

what is the most widely used agent that lowers urate levels for prevention of gout

allopurinol

what are the strongly recommended treatments for acute gout flares

use of injectable corticosteroid for quick pain relief in clinic or ER

what are 2 considerations dentists must be aware of in regards to gout

1) connection between hyperuricemia and periodontitis

2) some gout agents may have DDIs with drugs used in dentistry