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The patient has failed on Hydroxychloroquine if no symptom relief has developed in _________.
What is the main advantage of Hydroxychloroquine?
No myelosupression, hepatic or renal toxicities
What are the adverse effects of Hydroxychloroquine?
- GI distress
- Ocular toxicities
What clinical monitoring is needed with Hydroxychloroquine treatment?
- Baseline eye exam
- Opthalmoscopy every 9-12 months for vision changes
What is the Amsler grid?
A grid used to test for ocular issues associated with Hydroxychloroquine use
What is the usual dose for Sulfasalazine?
- 500 mg PO BID
- Titrate to 100 mg PO BID
What is the onset of symptom relief for Sulfasalazine?
Sulfasalazine is a prodrug cleaved in the intestines, what is the active form?
- 5-aminosalicylic acid
Sulfasalazine has higher concentrations in certain tissues what are they?
- Serous fluid
Does Sulfasalazine slow radiographic progression?
What are the AE of Sulfasalazine?
How should you monitor Sulfasalazine?
CBC, AST and ALT
What DDIs does Sulfasalazine have?
- Warfarin is displaced from protein by sulfasalazine
- Antibiotics can thwart prodrug activation in the intestines
- Iron chelates Sulfasalazine and decrease its absorption
TNF-alpha Biologics should be avoided with what concomitant disease state?
- Stage 3 or 4 HF
- Caution with stage 1 or 2
What are the main risks of all Biologic DMARDs?
- HF (TNF-alpha inhibitors)
Why should you not use Biologic DMARDs in people with recent cancer?
They block anti-cancer molecules and may cause malignancy
Infliximab produces symptom relief for RA in what time period?
Adalimumab produces symptom relief for RA in what time period?
Can you combine TNF-alpha inhibitors with methotrexate?
Can you combine TNF-alpha inhibitors with other biologic DMARDs?