Treatment

• What are DMARDs?

  Disease modifying anti-rheumatoid drugs

  Suppress body's overactive immune system -> improves symptoms & tests of inflammation

  May slow progression of arthritis & put patients into remission

  Have potential serious side effects (require monitoring)
• What is treat to target?

  Medical strategy that sets remission or low disease activity as goal

  If targets not reached, medications and/or doses are adjusted
• What are biological therapies?

  Target individual molecules & work more quickly than conventional DMARDs

  Only given to people who have already tried other treatments & not responded well

  Often given in combination w/DMARD
• What are the side effects with intra-articular steroid injections?

  Skin irritation

  Allergic reaction

  Moon face
• What are the risks of long-term steroid use?

  Immunosuppression

  Osteoporosis

  Skin atrophy/thinning

  Easy bruising

  Cushing's syndrome

  Withdrawal (if come off too fast)
• What is the interaction between trimethoprim & methotrexate?

  Both antagonise folate metabolism

  Both compete for secretion in renal tubules

  Trimethoprim displaces methotrexate from albumin
• Why are biosimilars used?

  Generally cheaper than original brand

  Just as safe & effective
• What is the the anchor drug of RA?

  Methotrexate
• Why is naproxen good?

  Better tolerated NSAID -> less likely to induce severe GI side effects

  Inhibits COX-2
• What is the function of COX-1?

  Predominantly responsible for regulating physiological functions (gastric acid secretion, renal blood flow & platelet aggregation)
• Why are steroids used with DMARDs?

  Conventional DMARDs are slow-acting whilst steroids are fast

  Steroids dampen down symptoms of inflammatory arthritis
• Why can DMARDs be used with NSAIDs?

  To reduce the total amount of medication needed & prevent further damage
• What the 2 types of DMARDs?

  Conventional DMARDs

  Biological therapies
• What is most commonly used steroid in RA?

  Prednisolone
• What is the difference between biosimilars & generics?

  Generics = exact copies of the original medicine

  Biosimilar = not completely identical to original medicine