Arthritis

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What is gout?
- Acute joint inflamation
- Also called “metabolic arthritis”
- caused by uric acid deposition in joints and tendons
- Provokes inflammatory response
discuss the treatment of gout
- Acute
- NSAIDS
- Steroids
- Colchicine
- Chronic
- Allopurinol
Describe mechanism of action of Allopurinol
- Inhibits xanthine oxidase
- Inhibits uric acid production
- Treatment of chronic gout
Describe the mechanism of action of colchicine
- inihibits microtubule polymerization
- inhibits phagocytosis
- also inhibits lactic acid production by WBC
- Treatment of acute gout
State the side effects of colchicine

diarrhoea, renal toxicity, bone toxicity rash, vomiting
What is osteoarthritis
- Also called Degenerative arthritis
- Slow progressive degeneration of joints
Discuss treatment of osteoarthritis
- Lifestyle modifications
- - weight loss
- Analgesics
- - paracetamol
- Steroids
- Colchicine
Discuss DMOAD
- Provide symptomatic improvement
- Glucosamine sulphate
- Chondroitin sulphate
- Diacerein
- Tetracylclines
- anakinra
What is rheumatoid arthritis?

Chronic, systemic, inflammatory disease of unknown etiology
State the effects of RA?
- Progressive joint destruction
- Loss of physical function
- Loss of quality of life
- Increased mortality
State 2 major cytokines in RA synovium
- IL-1
- TNF-a
Discuss treatment of RA
- NSAIDS
- Prednisone
- Parental steroids
- DMARDS
Discuss the use of DMARDS in RA
- Improve symptoms, function, and slow disease progression
- Monitoring is important
- Risk/benefit ratio with patients
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
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
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
Discuss side effects of Leflunomide
- Diarrhoea
- weight loss
- allopecia
- peripheral neuropathy
- abnormal LFT
- embryotoxic
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
Discuss anakinra in the treatment of RA
- Biological DMARD
- Competitively inhibits IL-1.
- Reduces PG production
- Reduces mononuclear cell infiltration
- Subcutaneous injection daily
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
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
State two kinds of monoclonal antibodies in RA
- Infliximab
- Certolizumab Pegol
Discuss use of infliximab in RA
- chimeric IgG1 monoclonal antibody
- binds to TNF-a
- IV administration every 8 weeks
- Must be used with MTX
Discuss use of Cimzia in RA
- Antbody against TNF-a
- Pegellated to mask antibody
- The sugar molecule is called Polyethylene glycol
What are side effects to be monitored with TNF-a antagonists
- Tuberculosis
- heart failure
- injection site reactions

Author

Bobopudge

57049

Card Set

Arthritis

Description

fungaa

Updated

2010-12-22T13:58:58Z

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