Rheumatoid Arthritis (RA) Treatment

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Questions and Answers

What is a key difference between NSAIDs and glucocorticoids in the treatment of RA?

Glucocorticoids prevent disease progression and joint damage (correct)

NSAIDs have a shorter duration of treatment

NSAIDs are more effective in reducing inflammation

Glucocorticoids are more effective in reducing pain

What is the recommended duration of low-dose glucocorticoid treatment in RA?

3 months or less (correct)

1 year or less

6 months or less

No time limit

What is the purpose of concomitant folic acid administration with methotrexate therapy?

To reduce the dose of methotrexate

To reduce the risk of folate-depleting reactions (correct)

To enhance the bioavailability of methotrexate

To increase the efficacy of methotrexate

What is the maximum weekly dose of methotrexate in RA treatment?

20 mg/week Signup and view all the answers

What is the primary goal of initiating disease-modifying therapy immediately in RA treatment?

To prevent long-term joint damage Signup and view all the answers

Why is methotrexate considered the csDMARD of choice in RA?

It has a better safety profile Signup and view all the answers

What type of therapy may be necessary for severe RA with extensive joint erosions?

Surgery to replace or reconstruct the joint Signup and view all the answers

What is the benefit of intra-articular administration of glucocorticoids in RA?

Rapid control of inflammation Signup and view all the answers

What is the purpose of 'bridge therapy' in RA treatment?

To provide symptomatic relief until the disease-modifying drug reaches its therapeutic effect Signup and view all the answers

What type of nonpharmacologic therapy may help patients with RA preserve joint function?

Occupational and physical therapy Signup and view all the answers

What is the primary benefit of NSAIDs in RA treatment?

Analgesic and anti-inflammatory benefits Signup and view all the answers

What is the classification of azathioprine, cyclosporine, and minocycline in RA treatment?

Disease-modifying anti-rheumatic drugs (DMARDs) Signup and view all the answers

What percentage of cases of juvenile idiopathic arthritis are systemic?

10% - 20% Signup and view all the answers

What is the typical pattern of fever in systemic juvenile idiopathic arthritis?

Twice daily spikes in fever Signup and view all the answers

Which type of juvenile idiopathic arthritis is more common in girls?

Oligoarticular Signup and view all the answers

What is the primary goal of treatment in rheumatoid arthritis?

All of the above Signup and view all the answers

What is essential for reducing disease progression and preventing joint damage in rheumatoid arthritis?

Early diagnosis and aggressive treatment Signup and view all the answers

What type of drugs are the mainstay of rheumatoid arthritis treatment?

Disease-modifying antirheumatic drugs (DMARDs) Signup and view all the answers

What is the initial treatment of choice for moderate to high disease activity in rheumatoid arthritis?

Methotrexate Signup and view all the answers

Why should combination therapy involving bDMARDs or tsDMARDs be avoided?

Due to increased risk of infection Signup and view all the answers

Study Notes

Nonpharmacologic Therapy

All patients should receive education about nonpharmacologic and pharmacologic measures to help manage RA and JIA
Occupational and physical therapy can help patients preserve joint function
Patients should be counseled about stress management
Surgery to replace or reconstruct the joint may be necessary if the disease has progressed to a severe form with extensive joint erosions

Pharmacologic Therapy

The current standard of care for RA treatment is to initiate disease-modifying therapy immediately
"Bridge therapy" or short-term use of certain medications can provide symptomatic relief until the disease-modifying drug reaches its therapeutic effect
NSAIDs and glucocorticoids are commonly used for bridge therapy

NSAIDs

Provide analgesic and anti-inflammatory benefits for joint pain and swelling
Do not prevent joint damage or change the underlying disease
Selection of an NSAID depends on patient-specific factors, including cardiovascular risk and potential for GI-related adverse events

Glucocorticoids

Low-dose glucocorticoid treatment can reduce inflammation through inhibition of cytokines and inflammatory mediators
Can prevent disease progression
Recommended duration is 3 months or less to avoid significant adverse reactions, especially bone loss leading to osteoporosis
Intra-articular administration of glucocorticoids may be considered in RA for rapid control of inflammation

Conventional Synthetic (cs)DMARDs

Methotrexate is the csDMARD of choice in RA due to its efficacy and safety profile
Once-weekly doses should be initiated and increased steadily until the patient has symptomatic improvement or a maximum dose of 20 mg/week is reached
Concomitant folic acid is given to reduce the risk of folate-depleting reactions induced by methotrexate therapy

Treatment

Desired outcomes of treatment in RA include reducing or eliminating pain, reducing disease activity, protecting articular structures and function, controlling systemic complications, and improving/maintaining quality of life
Early diagnosis and early aggressive treatment are necessary to reduce disease progression and prevent joint damage

DMARDs

DMARDs are the mainstay of RA treatment because they modify the underlying disease process
The umbrella term DMARD includes conventional synthetic (csDMARD), biologic (bDMARD), and targeted synthetic (tsDMARD)
Methotrexate is the initial treatment of choice for moderate to high disease activity
Combination therapy may be initiated at the time of diagnosis, but combination bDMARDs or tsDMARDs should be avoided due to the increased risk of infection

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Description

Learn about the different treatment options for Rheumatoid Arthritis (RA) including nonsteroidal anti-inflammatory drugs, glucocorticoids, and nonpharmacologic therapies.