40 Questions
Which of the following cytokines is NOT involved in the pathogenesis of RA?
IL-4
What is the main mechanism of action of TNF-α inhibitors?
Interfering with the binding of TNF-α to its receptor
Which of the following biologic therapies is indicated for monotherapy?
Rituximab
What is the main mechanism of action of Abatacept?
Preventing full T-cell activation
What is the main side effect of Rituximab?
Infusion reactions
Which of the following biologic therapies can be administered with TNF-α inhibitors?
Anakinra
What is the primary goal of DMARDS in treating rheumatoid arthritis?
To prevent further joints and tissue destruction
What is the preferred treatment approach for patients with moderate to high disease activity or inadequate response to monotherapy?
Combination DMARD therapy
What is the main mechanism of action of Tocilizumab?
Blocking the IL-6 receptor
What is the main indication of Tofacitinib?
Moderate to severe RA in patients who have had an inadequate response to methotrexate
What is the mechanism of action of methotrexate?
All of the above
What is the main mechanism of action of Anakinra?
Inhibiting the action of IL-1
What is the typical duration of response to methotrexate therapy?
3 to 6 weeks
What is the main advantage of Biological agents over glucocorticoids?
They are more effective in reducing progression of structural damage
What is a common side effect of hydroxychloroquine?
Ocular toxicity
What is the primary mechanism of action of leflunomide?
Cell arrest of autoimmune lymphocytes
What is a common side effect of minocycline?
None of the above
What is the typical duration of response to sulfasalazine therapy?
1 to 3 months
What is the primary indication for hydroxychloroquine?
All of the above
What is the preferred treatment approach for patients with more established disease?
Biologic therapy
What is the mechanism of action of methotrexate?
Folic acid antagonist by inhibition of dihydrofolate reductase enzyme
Which of the following DMARDs can be used as monotherapy or in combination with methotrexate?
Leflunomide
What is the typical response time to methotrexate therapy?
3 to 6 weeks
Which of the following is a side effect of minocycline?
Flu-like syndrome
What is the primary indication for hydroxychloroquine?
Early, mild rheumatoid arthritis
What is the onset of activity for sulfasalazine?
1 to 3 months
Which of the following DMARDs is used in the treatment of lupus?
Hydroxychloroquine
What is the common side effect of hydroxychloroquine?
Ocular toxicity
What is the mechanism of action of leflunomide?
Cell arrest of autoimmune lymphocytes
Which of the following DMARDs is a tetracycline antibiotic?
Minocycline
What is the primary effect of IL-1 and TNF-α on synovial cells?
stimulating collagenase synthesis
Which of the following biologic agents is NOT a TNF-α inhibitor?
Abatacept
What is the primary mechanism of action of Tofacitinib?
Inhibiting Janus kinases
What is the primary indication for Anakinra?
Treatment of moderate to severe RA in patients who have failed one or more DMARDs
What is the primary advantage of biological agents over glucocorticoids?
Reduced progression of structural damage
What is the primary side effect of Infliximab?
Infusion reactions
What is the primary mechanism of action of Rituximab?
Depleting B cells
What is the primary advantage of TNF-α inhibitors over non-TNF biologic therapies?
Can be administered with any other RA drug
What is the primary indication for Tocilizumab?
Treatment of moderate to severe RA
What is the primary mechanism of action of Abatacept?
Preventing full T-cell activation
Study Notes
DMARDs in Rheumatoid Arthritis
- Used to slow disease progression, induce remission, and prevent joint and tissue destruction.
- Monotherapy may be initiated for patients with low disease activity, while combination therapy is used for patients with moderate to high disease activity.
Methotrexate
- Used to treat rheumatoid or psoriatic arthritis, alone or in combination therapy.
- Response to methotrexate occurs within 3-6 weeks of starting treatment.
- Mechanism of action: inhibits dihydrofolate reductase enzyme, leading to immunosuppressive and anti-inflammatory effects.
- Side effects: mucosal ulceration, cytopenia, cirrhosis of the liver, and acute pneumonia-like syndrome.
Hydroxychloroquine
- Used for early, mild RA, often combined with methotrexate.
- Also used in the treatment of lupus and malaria.
- Side effects: ocular toxicity (irreversible retinal damage and corneal deposits).
Leflunomide
- Immunomodulatory agent causing cell arrest of autoimmune lymphocytes.
- Used as monotherapy or in combination with methotrexate.
- Side effects: allergic reactions, flu-like syndrome, skin rash, and hypokalemia, as well as hepatotoxicity in patients with liver disease.
Minocycline
- Tetracycline antibiotic effective in treating early RA, not used as first-line therapy.
- Used as monotherapy or in combination with other DMARDs.
Sulfasalazine
- Used in early, mild RA, often in combination with methotrexate and/or hydroxychloroquine.
- Onset of activity is 1-3 months.
Glucocorticoids
- Potent anti-inflammatory drugs that relieve symptoms and bridge the time until DMARDs are effective.
Biological Agents
- Decrease signs and symptoms of RA, reduce progression of structural damage, and improve physical function.
- Clinical response can be seen within 2 weeks of therapy.
TNF-α Inhibitors
- Interfere with the binding of TNF-α to its receptor.
- Indicated for treatment of moderate to severe RA, psoriatic arthritis, ankylosing spondylitis, and Crohn's disease.
- Examples: adalimumab, certolizumab, etanercept, golimumab, and infliximab.
- Side effects: increased risk of infections, fungal opportunistic infections, and pancytopenia.
Non-TNF Biologic Therapies
- Abatacept: prevents full T-cell activation, given as an IV infusion every 4 weeks.
- Rituximab: causes B-cell depletion, administered as an intravenous infusion every 16-24 weeks.
- Tocilizumab: inhibits the actions of IL-6, given as an intravenous infusion every 4 weeks.
- Tofacitinib: Janus kinase inhibitor, indicated for the treatment of moderate to severe RA in patients who have had an inadequate response or intolerance to methotrexate.
- Anakinra: IL-1 receptor antagonist, leads to a modest reduction in the signs and symptoms of moderate to severe RA in patients who have failed one or more DMARDs.
DMARDs in Rheumatoid Arthritis
- Used to slow disease progression, induce remission, and prevent joint and tissue destruction.
- Monotherapy may be initiated for patients with low disease activity, while combination therapy is used for patients with moderate to high disease activity.
Methotrexate
- Used to treat rheumatoid or psoriatic arthritis, alone or in combination therapy.
- Response to methotrexate occurs within 3-6 weeks of starting treatment.
- Mechanism of action: inhibits dihydrofolate reductase enzyme, leading to immunosuppressive and anti-inflammatory effects.
- Side effects: mucosal ulceration, cytopenia, cirrhosis of the liver, and acute pneumonia-like syndrome.
Hydroxychloroquine
- Used for early, mild RA, often combined with methotrexate.
- Also used in the treatment of lupus and malaria.
- Side effects: ocular toxicity (irreversible retinal damage and corneal deposits).
Leflunomide
- Immunomodulatory agent causing cell arrest of autoimmune lymphocytes.
- Used as monotherapy or in combination with methotrexate.
- Side effects: allergic reactions, flu-like syndrome, skin rash, and hypokalemia, as well as hepatotoxicity in patients with liver disease.
Minocycline
- Tetracycline antibiotic effective in treating early RA, not used as first-line therapy.
- Used as monotherapy or in combination with other DMARDs.
Sulfasalazine
- Used in early, mild RA, often in combination with methotrexate and/or hydroxychloroquine.
- Onset of activity is 1-3 months.
Glucocorticoids
- Potent anti-inflammatory drugs that relieve symptoms and bridge the time until DMARDs are effective.
Biological Agents
- Decrease signs and symptoms of RA, reduce progression of structural damage, and improve physical function.
- Clinical response can be seen within 2 weeks of therapy.
TNF-α Inhibitors
- Interfere with the binding of TNF-α to its receptor.
- Indicated for treatment of moderate to severe RA, psoriatic arthritis, ankylosing spondylitis, and Crohn's disease.
- Examples: adalimumab, certolizumab, etanercept, golimumab, and infliximab.
- Side effects: increased risk of infections, fungal opportunistic infections, and pancytopenia.
Non-TNF Biologic Therapies
- Abatacept: prevents full T-cell activation, given as an IV infusion every 4 weeks.
- Rituximab: causes B-cell depletion, administered as an intravenous infusion every 16-24 weeks.
- Tocilizumab: inhibits the actions of IL-6, given as an intravenous infusion every 4 weeks.
- Tofacitinib: Janus kinase inhibitor, indicated for the treatment of moderate to severe RA in patients who have had an inadequate response or intolerance to methotrexate.
- Anakinra: IL-1 receptor antagonist, leads to a modest reduction in the signs and symptoms of moderate to severe RA in patients who have failed one or more DMARDs.
Learn about the role of DMARDS in treating Rheumatoid Arthritis, including slowing disease progression, inducing remission, and preventing joint damage. Understand when to use monotherapy or combination therapy and the role of biologics.
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