Rheumatoid Arthritis

Get Started. It's Free
or sign up with your email address
Rheumatoid Arthritis by Mind Map: Rheumatoid Arthritis

1. Non-Biologic DMARDS (1st line)

1.1. MTX (first line)

1.1.1. Dose: 7.5, 15, 20mg once weekly (max 250) PLUS folic acid 1mg daily

1.1.2. MOA: Inhibits dihydrofolate reductase resulting in interfering with DNA synthesis

1.1.3. CI: Pregnancy (X), liver disease

1.1.4. ADRs: Ulcerative stomatitis, N/V, GI distress, leukopenia, infection risk, pulmonary/liver toxicity

1.1.5. DDIs: Phenytoin, salicylates, sulfonamides, NSAIDS

1.1.6. Monitoring: LFTs, Scr

1.2. Hydroxychloroquine

1.2.1. Dose: 200-400mg per day

1.2.2. ADRs: HA, N/V/D, retinopathy, photosensitivity, rash

1.2.3. Monitoring: LFTs, opthalamic exams (base and annual after 5 years of use)

1.3. Sulfasalazine

1.3.1. ADRs: HA, rash, N/V, dyspepsia

1.3.2. Monitoring: CBC with diff, dermatologic toxicity, G6PD deficiency

1.3.3. DDIs: NSAIDS, MTX (enhances hepatotoxicity)

1.4. Leflunomide (less commonly used)

1.4.1. Dosing: 10, 20mg tablets

1.4.2. ADRs: Alopecia, skin rash, elevated LFTs, interstitial lung disease

1.4.3. Monitoring: signs of severe infection/pulmonary symptoms, teratogenic

2. Biologic DMARDS

2.1. Non-TNFs (3rd line)

2.1.1. Rituximab

2.1.1.1. Dosing: IV

2.1.1.2. ADRs: Peripheral edema, neuropathy, fatigue, blood dyscrasias

2.1.1.3. DDIs: Diminished effect of vaccines

2.1.1.4. Monitoring: Hypersensitivity (angioedema), cardiac monitoring with BP and ECG

2.1.2. Tocilizumab

2.1.2.1. ADRs: Increased serum cholesterol, increased LFTs, HTN, neutropenia

2.1.2.2. DDIs: Macrolide, azoles, warfarin, HIV meds

2.1.2.3. Monitoring: LFTs, bilirubin, lipids

2.1.3. Abatacept

2.1.3.1. ADRs: HA, infection (URI), N

2.1.3.2. Diminished effect of vaccines

2.1.4. Tofacitinib

2.1.4.1. MOA: Inhibits Janus kinase (JAK)

2.1.4.2. ADRs: HTN, anemia

2.1.4.3. DDIs: Cyclosporine, azathioprine, tacrolimus, rifampin, clarithro/erythromycin (increase concentration), azoles (increase concentration)

2.1.4.4. CI: Do not initiate if lymphocytes <500, neutrophils <1000, or hemoglobin <9

2.1.4.5. Monitoring: Hemoglobin, lipids, HR, BP

2.2. TNFs (2nd line)

2.2.1. Mabs

2.2.1.1. Adalimumab

2.2.1.1.1. Dosing: Sub Q weekly or every other week

2.2.1.1.2. ADRs: Skin rash, injection site reaction, increased phosphokinase

2.2.1.1.3. DDIs: Cyclosporine, warfarin + theophylline

2.2.1.2. Infliximab

2.2.1.2.1. Dosing: IV maintenance 3mg/kg Q8 weeks

2.2.1.2.2. ADRs: Increased ALT, infection (URI), infusion related reaction

2.2.1.2.3. DDIs: Immunosuppressant toxicity, diminished effects of vaccines

2.2.1.2.4. Monitoring: HBV/TB screen, worsening CHF, LFTs

2.2.1.3. Golimumab

2.2.1.3.1. Dosing: IV every 8 weeks, Sub Q monthly

2.2.1.3.2. ADRs: Infection, infection (URI)

2.2.1.3.3. DDIs: Diminished effect of vaccines

2.2.2. Non-mabs

2.2.2.1. Entanercept

2.2.2.1.1. Dosing: Sub Q weekly

2.2.2.1.2. ADRs: Infection (URI), injection site reaction

2.2.2.1.3. DDIs: Immunosuppressant toxicity, diminished effects of vaccines

2.2.2.1.4. Monitoring: HBV/TB screen, signs/sx of infection or malignancy

2.2.2.2. Certolizumab

2.2.2.2.1. Dosing: Sub Q

2.2.2.2.2. ADRs: N, infection (URI)

2.2.2.2.3. DDIs: Diminished effect of vaccines