Arthritis

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Author:
Bobopudge
ID:
57049
Filename:
Arthritis
Updated:
2010-12-22 08:58:58
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  1. What is gout?
    • Acute joint inflamation
    • Also called “metabolic arthritis”
    • caused by uric acid deposition in joints and tendons
    • Provokes inflammatory response
  2. discuss the treatment of gout
    • Acute
    • NSAIDS
    • Steroids
    • Colchicine
    • Chronic
    • Allopurinol
  3. Describe mechanism of action of Allopurinol
    • Inhibits xanthine oxidase
    • Inhibits uric acid production
    • Treatment of chronic gout
  4. Describe the mechanism of action of colchicine
    • inihibits microtubule polymerization
    • inhibits phagocytosis
    • also inhibits lactic acid production by WBC
    • Treatment of acute gout
  5. State the side effects of colchicine
    diarrhoea, renal toxicity, bone toxicity rash, vomiting
  6. What is osteoarthritis
    • Also called Degenerative arthritis
    • Slow progressive degeneration of joints
  7. Discuss treatment of osteoarthritis
    • Lifestyle modifications
    • - weight loss
    • Analgesics
    • - paracetamol
    • Steroids
    • Colchicine
  8. Discuss DMOAD
    • Provide symptomatic improvement
    • Glucosamine sulphate
    • Chondroitin sulphate
    • Diacerein
    • Tetracylclines
    • anakinra
  9. What is rheumatoid arthritis?
    Chronic, systemic, inflammatory disease of unknown etiology
  10. State the effects of RA?
    • Progressive joint destruction
    • Loss of physical function
    • Loss of quality of life
    • Increased mortality
  11. State 2 major cytokines in RA synovium
    • IL-1
    • TNF-a
  12. Discuss treatment of RA
    • NSAIDS
    • Prednisone
    • Parental steroids
    • DMARDS
  13. Discuss the use of DMARDS in RA
    • Improve symptoms, function, and slow disease progression
    • Monitoring is important
    • Risk/benefit ratio with patients
  14. What is methotrexate? What is its mechanism of action?
    • DMARD
    • Inhibits dihydrofolate reductase
    • Inhibit terahydrofolate production (1-Carbon donor in purine synthesis)
    • Inhibit WBC proliferation
    • Also inhibits IL-1 and LTB4
  15. Discuss side effects of methotrexate
    • Just add folate
    • - GI disturbance
    • - Allopecia
    • - Rash
    • - Stomatitis
    • Monitor for these:
    • - liver and kidney disease
    • - myelosuppression
    • Rare
    • - lung fibrosis
    • Stop treatment 3 months before:
    • - embrytoxic
  16. What is Leflunamide? What is its mechanism of action?
    • DMARD
    • Inihibits dihydro-orotate dehydrogenase
    • Inihibits uridine monophosphate
    • Inhibits cell cycle progression in WBC
    • Less activation of NFkB
    • - which means less expression of inflamatory cytokines
    • More activation of Transforming growth factor-B
    • - which means more expression of inhibitory cytokines
    • Less formation of osteoclasts
  17. Discuss side effects of Leflunomide
    • Diarrhoea
    • weight loss
    • allopecia
    • peripheral neuropathy
    • abnormal LFT
    • embryotoxic
  18. State the function and four examples of biological DMARDS in arthritis
    • They inhibit cytokines involved in RA
    • Antibodies against receptor
    • Receptor antagonists
    • Soluble receptors which bind to ligand
    • Destroy membrane component in receptor
  19. Discuss anakinra in the treatment of RA
    • Biological DMARD
    • Competitively inhibits IL-1.
    • Reduces PG production
    • Reduces mononuclear cell infiltration
    • Subcutaneous injection daily
  20. What is anakinra and what is its major side effect
    • It is a IL-1 receptor antagonist
    • Competitively blocks IL-1
    • Side effect: Injection site reactions
  21. State two kinds of soluble receptors used in treatment of RA
    • Etanercept (binds to IL-1)
    • Rilonacept (binds to TNF-a and TNF-b)
    • dimeric molecules
  22. State two kinds of monoclonal antibodies in RA
    • Infliximab
    • Certolizumab Pegol
  23. Discuss use of infliximab in RA
    • chimeric IgG1 monoclonal antibody
    • binds to TNF-a
    • IV administration every 8 weeks
    • Must be used with MTX
  24. Discuss use of Cimzia in RA
    • Antbody against TNF-a
    • Pegellated to mask antibody
    • The sugar molecule is called Polyethylene glycol
  25. What are side effects to be monitored with TNF-a antagonists
    • Tuberculosis
    • heart failure
    • injection site reactions

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