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Flashcards in Approach to Therapeutics Deck (12)
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What approaches are there in the treatment of inflammatory arthritis?



What therapeutic categories are there?

-Non steroidal anti inflammatory drugs (NSAID)
-Disease Modifying anti Rheumatic drugs (DMARD)
-Corticosteroids (oral, i-m, i-a)


What are disease modifying anti rheumatic drugs?

-A group of structurally unrelated, typically small molecule drugs which have been demonstrated to have slow onset effect on disease activity and retard disease progression.
-Traditionally, these have been associated with identifiable toxicity profiles and risk of occasional serious adverse event.


What DMARDs are used in RA?



What DMARDS are not used in RA any more?

-Gold salts


What are the general approaches principles for inflammatory joint disease?

-Early and aggressive intervention is the key to obtaining optimal outcomes in the management of RA
-Effective suppression of inflammation will improve symptoms and prevent joint damage and disability


What's so special about methotrexate?

-Effective, well tolerated and cheap
-Cornerstone of combination treatment (with DMARD and biologic)
-People stay on it


What treatment strategies can be used for RA?

-Sequential -Monotherapy
-Combination: step up, step down and parallel
Treat to Target


What are biologics?

-Biologic DMARDs have been developed from improved understanding of immunology to target key aspects of inflammatory cascade.
-Typically these are large complex proteins which need to be given parenterally.
-Compared to traditional DMARD, they work rapidly, are generally well tolerated although with important toxicities (eg infection and come at high cost.


Give examples of biologics currently used?

-TNFa inhibitors (x5)
-IL-1 inhibitors (Anakinra)
-Anti B Cell therapies (CD20, Rituximab)
-Anti T Cell therapies (Abatacept)
-IL-6 inhibitors (Tocilizumab)


What issues are there with biologics?

-Efficacy: they have an enhanced response when co prescribed with methotrexate
-Toxicity: minor including injection site reactions to infection and ?malignancy


How are corticosteroids used in RA?

-Corticosteroids can be prescribed by mouth, by i-a or i-m injection and by i-v infusion
-Short term benefit v long term toxicity
-Rarely appropriate as single drug therapy