Rheumatoid Arthritis Medications Quiz
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Which drug is a folic acid antagonist and primarily used for its immunosuppressant properties in rheumatoid arthritis?

  • Hydroxychloroquine sulfate
  • Sulfasalazine
  • Methotrexate (correct)
  • Leflunomide

    • Which DMARD is known for its longer half-life and the risk of hepatic failure?

  • Azathioprine
  • Sulfasalazine
  • Methotrexate
  • Leflunomide (correct)

    • Which of the following is NOT commonly used as a DMARD due to the availability of better alternatives?

  • Hydroxychloroquine sulfate
  • Leflunomide
  • Ciclosporin (correct)
  • Methotrexate

    • What is the primary mechanism of action through which sulfasalazine exerts its anti-inflammatory effects?

    <p>Inhibiting prostaglandins and leukotrienes</p> Signup and view all the answers

    What significant side effect is associated with methotrexate treatment?

    <p>Mucositis and hepatotoxicity</p> Signup and view all the answers

    Which drug's therapeutic effect requires co-administration of folic acid supplements to reduce side effects?

    <p>Methotrexate</p> Signup and view all the answers

    Which DMARD acts by blocking dihydroorotate dehydrogenase?

    <p>Leflunomide</p> Signup and view all the answers

    Which side effect is shared by both methotrexate and sulfasalazine?

    <p>GI disturbances</p> Signup and view all the answers

    Which DMARD is specifically indicated for its anti-inflammatory effects through inhibition of pro-inflammatory cytokines?

    <p>Sulfasalazine</p> Signup and view all the answers

    What is a major concern when using immunosuppressant drugs like methotrexate and leflunomide?

    <p>Increased susceptibility to infections</p> Signup and view all the answers

    What is the primary goal in treating rheumatoid arthritis early in the disease?

    <p>To control the disease early on</p> Signup and view all the answers

    Which drug class is classified as having little effect on disease progression in RA?

    <p>NSAIDs</p> Signup and view all the answers

    What is a known side effect of glucocorticoids such as prednisolone?

    <p>Cushing Syndrome</p> Signup and view all the answers

    What type of DMARDs may limit the progression of rheumatoid arthritis?

    <p>Conventional DMARDs (cDMARDs)</p> Signup and view all the answers

    Which glucocorticoid formulation is designed to release medication in accordance with circadian rhythms?

    <p>Lodotra (prednisone)</p> Signup and view all the answers

    What mechanism do glucocorticoids primarily use to exert their anti-inflammatory action?

    <p>Inhibit inflammatory cell action</p> Signup and view all the answers

    What is the method of administration for glucocorticoids mentioned in the content?

    <p>Oral, intramuscular or intraarticular</p> Signup and view all the answers

    Which of the following cytokines is NOT mentioned as being inhibited by glucocorticoids?

    <p>IL-4</p> Signup and view all the answers

    What is the potential benefit of using Lodotra over standard prednisone?

    <p>Improved early-morning joint stiffness</p> Signup and view all the answers

    In the context of rheumatoid arthritis, which of the following is NOT a part of the overall treatment approach?

    <p>Exclusive surgical intervention</p> Signup and view all the answers

    What is the primary mechanism of action for drugs that aim to prevent autoimmune responses in rheumatoid arthritis?

    <p>Prevent antigen processing by immune cells</p> Signup and view all the answers

    Which of the following biological DMARDs is NOT indicated for moderate to severe rheumatoid arthritis?

    <p>Rituximab</p> Signup and view all the answers

    Which of the following targets IL-6 in its mechanism of action?

    <p>Sarilumab</p> Signup and view all the answers

    In the treatment of rheumatoid arthritis, when is the use of biological DMARDs generally recommended?

    <p>After failure of one conventional DMARD</p> Signup and view all the answers

    What concern is associated with overdosing on certain RA treatments?

    <p>Cardiovascular and psychiatric effects</p> Signup and view all the answers

    Which class of biological DMARDs would likely be prescribed alongside methotrexate in a triplet therapy for rheumatoid arthritis?

    <p>Cytokine inhibitors</p> Signup and view all the answers

    Which of the following biological DMARDs is a fusion protein designed to act as a decoy receptor for TNF?

    <p>Etanercept</p> Signup and view all the answers

    What is the classification of Sarilumab in the context of RA treatment?

    <p>Human monoclonal antibody</p> Signup and view all the answers

    Which of the following factors is a critical consideration when using biological DMARDs?

    <p>Potential for immunogenicity</p> Signup and view all the answers

    What is the role of Rituximab in rheumatoid arthritis treatment?

    <p>Treatment for patients unresponsive to anti-TNF therapy</p> Signup and view all the answers

    Which class of drugs is primarily used in the treatment of rheumatoid arthritis to reduce inflammation and prevent joint damage?

    <p>DMARDs</p> Signup and view all the answers

    What is the primary immune response type involved in rheumatoid arthritis?

    <p>Th1 immune response</p> Signup and view all the answers

    Which of the following cytokines is NOT typically associated with rheumatoid arthritis?

    <p>IL-10</p> Signup and view all the answers

    Which biological drug is specifically classified as a TNF-alpha inhibitor?

    <p>Infliximab</p> Signup and view all the answers

    Janus kinase (JAK) inhibitors are primarily used to treat which type of conditions?

    <p>Autoimmune diseases</p> Signup and view all the answers

    What complication is most associated with the use of JAK inhibitors in treatment?

    <p>Serious infections</p> Signup and view all the answers

    At what point in the disease course of rheumatoid arthritis might a patient experience significant stiffness in the mornings that improves throughout the day?

    <p>In the early stages of the disease</p> Signup and view all the answers

    Which serological test is considered most specific for diagnosing rheumatoid arthritis?

    <p>Anti-CCP antibodies</p> Signup and view all the answers

    What is the typical treatment approach for rheumatoid arthritis?

    <p>Long-term use of DMARDs and biologics</p> Signup and view all the answers

    Which of the following drugs is a synthetic DMARD used in rheumatoid arthritis treatment?

    <p>Tofacitinib</p> Signup and view all the answers

    Study Notes

    Rheumatoid Arthritis Treatment

    • Rheumatoid arthritis (RA) is a debilitating autoimmune disease
    • The initial impact of RA causes significant disability
    • The goal is to control RA early to minimize long-term effects
    • Treatment involves: patient education, healthcare professional management, medication, and surgery

    Drugs for RA

    • Anti-inflammatory drugs: These have little effect on disease progression
      • Nonsteroidal anti-inflammatory drugs (NSAIDs)
      • COX-2 inhibitors
      • Glucocorticoids (e.g., prednisolone)
    • Disease-Modifying Anti-Rheumatic Drugs (DMARDs): Compounds that may limit disease progression
      • Conventional DMARDs (cDMARDs)
      • Biologics

    Glucocorticoids (e.g., Prednisolone)

    • Useful "bridging" drug
    • Administered orally, intramuscularly, or intra-articularly
    • Actions: anti-inflammatory and immune suppression
      • Inhibit cytokine gene expression (IL-1, IL-2, IL-6, TNFα)
      • Inhibit inflammatory cell action (decreasing T cell activity and proliferation)

    Side Effects of Glucocorticoids (Cushing Syndrome)

    • Euphoria (though sometimes depression or psychosis)
    • Emotional lability
    • Buffalo hump
    • Hypertension
    • Moon face (plethoric cheeks)
    • Increased abdominal fat
    • Avascular necrosis of femoral head
    • Easy bruising
    • Thinning skin
    • Thin arms and legs, muscle wasting
    • Poor wound healing
    • Osteoporosis
    • Tendency to hyperglycemia
    • Negative nitrogen balance
    • Increased appetite
    • Increased susceptibility to infection
    • Obesity

    Steroid Formulations (e.g., Lodotra)

    • Prednisone modified-release formulation
    • Activated approximately 6 hours post-ingestion
    • Taken with water, after food; do not chew
    • Released to coincide with circadian rhythms of cortisol & disease symptoms (peak early morning)
    • Studies show improvement in early morning joint stiffness symptoms

    DMARDs (Disease-Modifying Anti-Rheumatic Drugs)

    • Conventional DMARDs (e.g., methotrexate, azathioprine, cyclosporin, leflunomide, sulfasalazine, sodium aurothiomalate, penicillamine, hydroxychloroquine sulfate)
    • Biologic DMARDs
    • Effective in limiting disease progression
    • 90% of RA joint involvement occurs within the first year; early aggressive treatment is crucial.

    DMARDS Effects

    • Shown to reduce swelling, pain, and improve joint function

    cDMARDs (Conventional DMARDs)

    • Methotrexate
    • Azathioprine
    • Cyclosporin
    • Leflunomide
    • Sulfasalazine
    • Sodium aurothiomalate
    • Penicillamine
    • Hydroxychloroquine sulfate

    Immunosuppressants

    • Induce and maintain remission, but impair immune response (i.e., increasing susceptibility to infection)
    • Methotrexate and leflunomide are commonly used .
    • Azathioprine and ciclosporin are less frequently used due to better alternatives

    Methotrexate

    • Folic acid antagonist and inhibitor of dihydrofolate reductase. Inhibits DNA synthesis
    • Also interferes with IL-1 proinflammatory actions
    • Also promotes adenosine release (anti-inflammatory)
    • Side effects: myelosuppression, mucositis, GI disorders, hepatotoxicity, pneumonitis, teratogenic
    • Co-administration of folic acid supplements reduces myelosuppression and mucositis

    Leflunomide

    • Prodrug converted to teriflunomide in the body
    • Inhibits pyrimidine synthesis (blocking dihydroorotate dehydrogenase)
    • Targets rapidly dividing cells (T-cells)
    • Used for moderate to severe rheumatoid arthritis
    • Side effects: GI disturbances, peripheral neuropathy, risk of hepatic failure
    • Long half-life

    Sulfasalazine

    • Broken down by gut bacteria (azoreductase) to 5-aminosalicylate (5-ASA) and sulfapyridine
    • Absorbed into systemic circulation
    • Acts in the lumen to have anti-inflammatory effects
    • Therapeutic use through inhibition of PGs and LTs, and pro-inflammatory cytokines (IL-1, TNFα)
    • Side effects: GI disturbances, malaise, headache, severe adverse reactions (including reduced WBC counts, caused by sulfapyridine)

    Hydroxychloroquine sulfate

    • Weak DMARD with a slow onset of action
    • Prevents antigen processing by immune cells, preventing immune response
    • Effective against autoimmune responses
    • Use in mild RA, with methotrexate and sulfasalazine (triple therapy)
    • Potential serious side effects (especially with overdose), including cardiovascular and psychiatric effects

    Biological DMARDs

    • Many treatment options (see Canvas)
    • Recommended when conventional therapies are ineffective
    • Target numerous pathways in RA, specifically TNF alpha, other cytokines (e.g., IL-6), and other targets
    • Examples include: Etanercept, Infliximab, Anakinra, Abatacept, Tocilizumab, Sarilumab, Rituximab

    International Non-Proprietary Names (INNs) for Antibodies

    • Provides common names for antibodies used in RA treatment across different origins (Chimeric, Humanised, Human) e.g., Infliximab, Tocilizumab, Sarilumab

    Immunogenicity

    • Different antibody origins (murine, chimeric, humanized, human) exhibit varying levels of immunogenicity (i.e., a reduced reaction from the body)

    Biological Therapy for RA

    • Includes drugs such as Etanercept, Infliximab, Anakinra, Abatacept, Tocilizumab, Sarilumab, Rituximab
    • Used in conjunction with methotrexate (MTX)
    • Targeting TNF, IL-1, IL-6 receptor, and other targets

    Treatment Flowchart NICE

    • Mono-therapy with cDMARDs (MTX, Leflu, Sulfasalazine, Hydroxychloroquine) for mild cases
    • MTX with Biological therapies (TNFalpha inhibitors)
    • Other biological drugs (e.g., Rituximab) with or without MTX
    • Other biological drugs (e.g., Sarilumab, tocilizumab) with or without MTX

    Other Compounds

    • Synthetic DMARDs (e.g., tofacitinib, baricitinib, upadacitinib)
    • Janus kinase (JAK) inhibitors
    • Used under expert supervision
    • Risks include: cardiovascular events, venous thromboembolism, malignancies, serious infections, and increased mortality

    Rheumatoid Arthritis vs. Osteoarthritis

    • Differentiated based on features like joint involvement patterns (symmetrical/asymmetrical), presence of nodules, and morning stiffness duration, cartilage loss, inflamed synovium
    • RA is autoimmune, while osteoarthritis is degenerative

    Key Differences between RA and OA

    These are summarized in a table

    Self-Assessment Questions

    • Questions about RA diagnosis, pathogenesis-implicated cytokines, differences between anti-inflammatory and immunosuppressant drugs, and biological drugs used for treatment.

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    Related Documents

    Clinical Therapeutics and Manufacturing (5LMS2015) - Rheumatoid Arthritis Lecture 2 PDF

    Description

    Test your knowledge on the various DMARDs used in treating rheumatoid arthritis. This quiz covers mechanisms of action, side effects, and important considerations when using these immunosuppressant drugs. Perfect for students and healthcare professionals interested in rheumatology.

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