Please enable JavaScript.
Coggle requires JavaScript to display documents.
CNSLF Med - RA (iii) (RA assessment in clinic (disease activity score…
CNSLF Med - RA (iii)
-
Biologic DMARDs
anti-TNF
expensive + used after @ least 2 DMARDs have failed (or earlier depending on patient's comorbidities)
-
requires pre-tx CXR, TB ELISPOT, viral screen (HBV, HCV, HIV, varicella - can cause reactivations)
-
etanercept, adalimumab, golimumab, infliximab, certolizumab pegol
SEs: infections, allergic + infusion reactions, increase risk of certain cancers, precipitate HF, reactivation of latent TB + HBV, rare cases of demyelination
-
-
-
-
-
-
Corticosteroids
usually for exacerbations, give @ 1st to induce remission, after that only for flares
-
-
-
oral
early short-term use, often as bridging tx when starting DMARDs
-
-
concomitant vit D, Ca + bisphosphonates if patient on steroids > 3 months
Conventional DMARDs
MTX
-
-
-
-
-
SEs: nausea, hepatotoxicity, mouth ulcers, BM suppressions, B12/folate deficiency. pul fibrosis
precautions with alcohol, renal impairment, liver disease
-
3 monthly monitoring of FBC, U+E, LFTs
-
-
sulfasalazine
-
-
-
-
-
risk of leucopenia, thrombocytopenia, GI upset, allergic reactions
Leflunomide
-
long half life, 10-20mg po per day
-
SEs: diarrhoea, HTN, abnormal LFTs, weight loss
-
Management
pharm
-
NSAIDs
-
avoid long term use, inform patients about risks for adverse events
monitor for adverse events: GI bleed (consider concomitant PPI) kidney injury, liver injury, CVD
-
-
-
goal = suppress inflamm, tx pain + prevent disability
-
-
non-pharm
-
-
-
exercise
improves function, fitness, strength
reduces CVD, depression, osteoporosis
-