DMARDs

Question 1

first line tx for knee and hip OA

Answer 1

• acetaminophen

- if contraindicated, use topical NSAIDs

Question 2

first line tx for hand OA

Answer 2

• under 75: oral NSAIDs

- 75 and older: topical NSAIDs

Question 3

methotrexate

Answer 3

• gold standard for treating RA
• non-biologic DMARD
• PO
• combo of methotrexate + another DMARD can increase efficacy (but also toxicity)

Question 4

AEs for methotrexate

Answer 4

• more common: N/V/D, alopecia, malaise
• less common: hepatotoxicity, nephrotoxicity, thrombocytopenia, bone marrow suppression
• take with folic acid to reduce GI, hepatic, and hematologic toxicity
• BOXED WARNING: increased risk of infection, lymphoma

Question 5

hydroxychloroquine (Plaquenil)

Answer 5

• non-biologic DMARD
• impacts mediators of inflammatory response
• PO
• used for other diseases such as lupus, malaria
• treats RA symptoms, but does nothing about progression

Question 6

AEs for hydroxychloroquine (Plaquenil)

Answer 6

• common: GI, skin reactions

- rare: retinal toxicity

Question 7

TNF-inhibitors

Answer 7

• biologic DMARDs
• IV or subcut
• etanercept (Enbrel) is delivered via auto-injector for self administration - disease progression may inhibit adherence
• adalimumab (Humira)

Question 8

AEs for TNF-inhibitors

Answer 8

• headache
• infection
• antibody development
• fever
• hypotension
• urticaria (hives)
• BOXED WARNING: lymphoma

Question 9

Non-TNF-inhibitors

Answer 9

• biologic DMARDs
• IV, subcut
• rituximab (Rituxan)
• self administration device is more user-friendly

Question 10

AEs for non-TNF-inhibitors

Answer 10

• injection/infusion rxn

- increased LFT, antibody development

Question 11

janus-kinase inhibitors

Answer 11

• PO (molecules are small enough)
• common AE: infection, nasopharyngitis
• Boxed Warning: serious infections, secondary malignancies

Question 12

rehab concerns with DMARDs

Answer 12

• assist pts with injections
• infection risk - don’t overwash hands
• review labs
• skin rashes
• renal effects (keep pt hydrated)
• bone marrow suppression
• easily bruised
• anemia
• fatigue

Question 13

what happens when you combine DMARDs and high-dose steroids (like corticosteroids)?

Answer 13

-Catabolic effect → breaking muscle down
-Be careful w strengthening, stretching, deep tissue
work