RA

Question 1

RA can be triggered by?

Answer 1

vaccines!!!

Question 2

RA- drug classes

Answer 2

Immunosuppression/antiprolif:
-DMARDs (disease modifying anti-rheumatoid drugs)
-anti-TNFalpha, anti-IL-1 ab’s/antagonists (Biological agents)
-Janus kinase inhibitor (Signal Modulation)
Anti-infl:
-glucocorticoids

Question 3

DMARDs- drugs

Answer 3

(antiprolif, immunosuppressive)
-Hydroxychloroquine
-Leflunomide- inhibits dihydroorotate dehydrogenase
-Methotrexate- inhibits DHFR
-Sulfasalazine
(HLMS)

Question 4

frontline DMARD for mild/moderate RA?

Answer 4

-low-dose Methotrexate

Question 5

MTX- moa

Answer 5

• pro-drug- becomes MTX-(glu)n (takes 25-30 wks)
• inhibits DHFR: DHF–DHFR-> THF–> Thymidine, purines)- anti-prolif, immunosuppressive!
• inhibits AICAR TFase: AICAR –> F-AICAR
• AICAR buildup–> Adenosine- anti-infl!!!

Question 6

MTX- bioavailability, clearance

Answer 6

• Oral- variable absorbed
• parenteral (IM,SC)- inc bioavailability!!
• cleared via kidneys

Question 7

MTX- toxicities

Answer 7

• hepatotoxicity- do liver fxn tests!!
• pulm damage- hypersensitivity
• myelosuppression
• take folic acid to prevent hematologic SE’s!!

Question 8

withdrawal of MTX

Answer 8

-flare of RA within 3-6 wks

Question 9

pts who dont respond to MTX- do what

Answer 9

combo of MTX And other DMARDs

Question 10

Anti-infl glucocorticoids- moa

Answer 10

• repress transcription of infl cytokines- repress NFkB TF
• tx acute flares- therapeutic bridge b/w initiation of and response to DMARDs!!!
• SEs- osteoporosis, diabetegenic!!!

Question 11

Anti-infl corticosteroids- drugs

Answer 11

• prednisone
• methylprednisolone
• Triamcinolone hexacetonide

Question 12

Biological agents for RA (moderate to severe)

Answer 12

used in combo with low dose MTX

-anti-TNF agents

Question 13

Anti-TNF agents

Answer 13

• TNF R- Etanercept
• Anti-TNF monoclonal ab’s- Infliximab, Adalimumab
• R antagonist- Anakinra

Question 14

TNF R

Answer 14

Etanercept

Question 15

Anti-TNF monoclonal ab’s

Answer 15

• Infliximab

- Adalimumab

Question 16

TNF-alpha agents- safety issues

Answer 16

-inc risk of serious infections!!!- TB

Question 17

other biologic agents

Answer 17

• Certolizumab pegol- TNFalpha ab

- Golimumab- TNFalpha ab

Question 18

Tofacitinib- indication, moa

Answer 18

• tx moderate-severe RA who have had an inadequate response to or are intolerant to MTX
• JAK inhibitor (inhibits infl cytokines)

Question 19

Tofacitinib- cautions

Answer 19

-do NOT have any vaccines!!!
-may lower body’s resistance and the vaccine may not work or might get the infection the vaccine is meant to prevent
(avoid contact with ppl in your household who receive live virus vaccines)