causes chronic inflammation of the joints and other organs in the body, including the kidneys, eyes, heart and lungs.

Inflammation leads to cartilage and bone destruction, resulting in the classic symptoms of RA: joint swelling, stiffness, pain and, eventually, bone deformity

The goal is to have the patient on a Disease-Modifying Antirheumatic Drug (DMARD) within 3 months of diagnosis.

Those with severe cases of RA may require use of newer biologic agents. What are they and what are their benefits, if any?

Etanercept, adalimumab and infliximab. Each can be used with methotrexate. Said biologics have adverse effects, are costly, and do not work well for everyone but for many patients they significantly increase mobility and the quality of life

Ibuprofen;

Celecoxib;

Prednisone

NSAID

Cardiovascular risk: NSAIDs may cause an increase risk of serious CV thrombotic events, MI, and stroke, which can be fatal

Gastroinetestinal: NSAIDs cause an increased risk of serious GI adverse events including bleeding, ulceration, and perforation of the stomach

Pregnancy cat C prior to 30 weeks

Pregnancy cat D starting at 30 weeks

No. For acute inflammation use only - steroids are not supposed to be used long-term - however, many patients use chronically due to severity of disease

assess bone density and consider use of biphosphonates, optimize calcium and vitamin D intake

Yes. If used longer than 2 weeks, taper dose off to avoid withdrawal symptoms

Fluid retention, emotional instability (euphoria, mood swings, depression, insomnia), if high dose, can get an acute rise in blood glucose, possible rise in blood pressure.

Adrenal suppression/Cushing's syndrome, impaired wound healing, hypertension, hyperglycemia, cataracts, osteoporosis &c.

Name the Non-biologic Disease-Modifying Anti-rheumatic drugs (DMARDs) of note

Methotrexate;

Hydroxychloroquine

NO. Used in low weekly doses for RA, or split into smaller doses. NEVER DAILY

Must have negative pregnancy test before starting this medicine and use 2 forms of birth control.

If want to get pregnant, wait 2 years after discontinuation or give cholestryamine

Etanercept;

Adalimumab;

Infliximab;

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Which of the biologics are self-injectable and considered first within the biologics?

NO! Requires refrigeration (biologics will denature if hot). DO NOT FREEZE

No. usually, MTX is used 1st line and these agents are add-on therapy. However, if the initial presentation is severe, these can be started as initial therapy

All TNF inhibitors carry a black box warning for risk of serious infections