Rheumatoid arthritis and Osteoarthritis

Card Set Information

Author:
timothy.pdlt
ID:
211873
Filename:
Rheumatoid arthritis and Osteoarthritis
Updated:
2013-04-06 22:19:00
Tags:
RA OA
Folders:

Description:
therapeutics, side-effects, drug interactions
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  1. GoT of RA
    • 1. control S/S
    • 2. slow radiographic progression
    • 3. induce remission
    • 4. educate
    • 5. maintain function
  2. Epidemiology of RA
    • prevalence= 1%
    • 2-3x more common in women
  3. Common RA S/S
    • joint pain even at rest
    • swelling
    • deformity
    • maybe local redness/warmth
    • morning stiffness >30min
    • fatigue
  4. Classification of RA
  5. Poor prognostic factors for RA
    • early age of onset
    • positive RF, increased ESR/CRP
    • early erosions
    • >20 swollen joints
    • extra-articular S/S
  6. RA Tx guidelines
    1. rheumatologist referral within 6 weeks

    • 2. pain control/adjunctive Tx
    • a. NSAIDs= improves S/S but doesn't modify progression nor prevent damage
    • b. glucocorticoids= rapid S/S relief

    • 3. start DMARDs within 3 months
    • a. MTX±low dose prednisone
    • b. MTX+SSZ+HCQ>>any alone

    • 4. suboptimal MTX responders
    • a. combination (ie. MTX+SSZ+HCQ)
    • b. TNF blockers±MTX (gold standard)
  7. S/E of NSAIDs
    • dyspepsia
    • heartburn
    • GI ulceration
    • renal insufficiency
    • inhibits platelet aggregation
  8. S/E of glucocorticoids
    • CNS: psychosis, change in mood
    • HEENT: glaucoma, cataracts
    • CV: electrolyte imbalance, edema, HTN, renal/hepatic dysfunction
    • GI: PUD, pancreatitis
    • ENDO: DM, fat redistribution, dyslipidemia
    • MSK: osteoporosis, osteonecrosis, myopathy
    • SK: acne, hirsutism, alopecia
    • ID: skin infections
  9. Dose of MTX for RA
    • MTX 7.5-25mg PO/SC/IM once weekly
    • must add folic acid 5-27.5mg/week on the day without MTX

    • onset: 2 months
    • benefit in 60-70% of patients
  10. S/E of MTX
    • mucositis
    • GI disturbances
    • hepatic fibrosis
    • cirrhosis
    • teratogenicity
    • myelosuppresion (uncommon in <20mg/week)
    • pneumonitis
    • mild alopecia
  11. Dose of HCQ for RA
    HCQ 200-400mg QD

    doesn't slow down radiographic progression
  12. S/E of HCQ
    • visual changes (eye q6-12months)
    • GI S/S
    • rash
    • myopathy
    • peripheral neuropathy
  13. Dose of SSZ for RA
    SSZ 500mg/d-->1-3g/d in divided doses

    slows radiographic progression
  14. S/E of SSZ
    • sulfa allergy
    • oligospermia
    • myelosuppression
    • GI S/S
    • HA
    • skin rash
    • photosensitivity
  15. Dose of leflunomide for RA
    leflunomide 100mg x3days then 10-20mg QD

    similar efficacy as MTX and SSZ
  16. Washout procedure for leflunomide
    • 1. cholestyramine 8g TID x11days
    • 2. then check plasma levels 2 weeks apart
  17. S/E of leflunomide
    • teratogenicity
    • hepatotoxicity (esp. w/ hepatotoxic drugs)
    • GI S/S
    • weight loss
    • rash
    • HTN
  18. S/E of gold (used for RA)
    • oral ulcers
    • rash
    • myelosuppression
    • proteinuria
    • vasomotor reaction if parenteral

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