Home' Australian Pharmacist : Australian Pharmacist April 2013 Contents 62
Australian Pharmacist April 2013 I ©Pharmaceutical Society of Australia Ltd.
1. Choose the CORRECT statement
about rheumatoid arthritis.
a) Onset is most often before the age of
30 or after the age of 65 years.
b) It occurs 2 to 3 times more frequently
in men than in women.
c) There is an increased risk of
cardiovascular morbidity and
d) It is characterised by persistent
asymmetric joint inflammation.
2. Cigarette smoking increases the
risk of cardiovascular disease by a
number of different mechanisms
a) prolonged increases in blood pressure.
b) decreased inflammatory cytokines.
c) accelerated atherosclerotic plaque
d) increased heart rate.
a) is more effective at preventing
cardiovascular events in RA than other
b) reduces the chronic inflammatory
process in RA by increasing
c) can cause dose-dependent
hypertension and an increase in
d) improves disease-specific outcomes
and reduces atherosclerotic
4. Choose the CORRECT statement
a) Hypertension is dose-dependent
and occurs in approximately 20%
of patients receiving high-dose
b) Intra-articular injections are
administered once every 24 hours into
individually inflamed joints.
c) There is a delay in the onset of
action of intra-articular injections by
d) The dose and frequency of intra-
articular injections is the same
regardless of the injection site.
5. Leflunomide-related hypertension:
a) has been reported to occur in up to
3.7% of patients.
b) can be managed with a dose
reduction or concurrent
c) usually develops within the first
2 weeks of treatment.
d) causes peak increases in systolic blood
pressure of around 15 mmHg.
1. Rheumatoid arthritis [revised Nov 2012]. The Merck Manual [online]. At:
2. Temprano KK. Rheumatoid arthritis [revised Feb 2013]. Medscape
Reference [online]. At: http://emedicine.medscape.com/article/331715
3. Australian Institute of Health and Welfare Australian Institute of Health
and Welfare 2010. A snapshot of arthritis in Australia 2010. Arthritis
series no. 13. Cat. no. PHE 126. Canberra: AIHW; 2010.
4. Van Doornum S, Jennings GLR, Wicks IP. Reducing the cardiovascular
disease burden in rheumatoid arthritis. MJA. 2006; 184(6):287–90.
5. Panoulas VF, Douglaas KMJ, Milionis HJ, et al. Prevalence and
associations of hypertension and its control in patients with
rheumatoid arthritis. Rheumatology 2007; 46(9):1477–82.
6. Van Doornum S, McColl G, Wicks IP. Accelerated atherosclerosis – an
extraarticular feature of rheumatoid arthritis? Arthritis & Rheumatism
7. Virdis A, Giannarelli C, Neves MF, et al. Cigarette smoking and
hypertension. Curr Pharm Des 2010;16(23):2518–25 .
8. Omvik P. How smoking affects blood pressure. Blood pressure
9. Saag KG, Cerhan JR, Kolluri S, et al. Cigarette smoking and rheumatoid
arthritis severity. Ann Rheum Dis 1997;56(8):463–9 .
10. The Royal Australian College of General Practitioners. Clinical guidelines
for the diagnosis and management of early rheumatoid arthritis
Aug 2009 [online]. At: www.racgp.org.au/download/documents/
11. eTG complete [Internet]. Melbourne: Therapeutic Guidelines; 2012.
12. Rheumatoid arthritis [revised Jul 2012]. BMJ Best Practice [online]. At:
13. Westlake SL, Colebatch AN, Baird J, et al. The effect of methotrexate on
cardiovascular disease in patients with rheumatoid arthritis: a systemic
literature review. Rheumatoloty 2010;49(2):295–307.
14. Habib GS. Systemic effects of intra-articular corticosteroids. Clin
Rheumatol 2009; 28:749–56.
15. Stephens MB, Beutler AI, O’Connor F. Musculoskeletal injections: a
review of the evidence. Am Fam Physician 2008;78(8):971–6 .
16. Grossman E, Messerli FH. Iatrogenic and drug-induced hypertension.
In: Secondary hypertension: clinical presentation, diagnosis and
treatment. Totowa, NJ: Humana Press Inc.; 2004.
17. Sholter DE, Armstrong W. Adverse effects of corticosteroids on
the cardiovascular system. The Canadian Journal of Cardiology
18. Rozman B, Praprotnik S, Logar D, et al. Leflunomide and hypertension.
Ann Rheum Dis 2002;61:567–9 .
19. Van Riel P, Smolen JF, Emery P, et al. Leflunomide: a manageable safety
profile. J Rheum 2004(Suppl);71:21–4 .
20. Shankaranarayana S, Barrett C, Kubler P. The safety of leflunomide.
Australian Prescriber 2013;36:28–32.
21. Jones PBB, White DHN. Reappraisal of the clinical use of leflunomide
in rheumatoid arthritis and psoriatic arthritis. Rheumatology: Research
and Reviews 2010;2:53–71 .
22. National Heart Foundation of Australia. Guide to management
of hypertension 2008. Updated Dec 2010 [online]. At:
Table 1. Medicines associated with
• Haemopoietic agents (darbepoetin,
• Immunosuppressants (cyclosporin,
• Non-steroidal antiinflammatory
• Oral contraceptives
• Oral decongestants (e.g.
• Stimulants (dexamphetamine
• Tricyclic antidepressants
• Venlafaxine (dose-related)
Key learning points
• Cardiovascular disease is a major
cause of morbidity and mortality in
• The excess cardiovascular disease
burden in patients with RA persists
after adjustment for traditional
cardiovascular risk factors
• Hypertension is a potential side
effect of a number of medicines
used in the treatment of RA
including NSAIDs, corticosteroids,
leflunomide and cyclosporin; blood
pressure should be monitored
in RA patients before beginning
these medicines and then at
PBS Information: This product is not listed on the PBS for stroke prevention in atrial fibrillation.
Authority required. Prevention of venous thromboembolism in a patient undergoing total hip or knee replacement.
NVAF occurs in the absence of a prosthetic valve or haemodynamically relevant valve disease requiring surgical intervention.
Pradaxa is contraindicated in patients with a prosthetic heart valve replacement.2 ‡Pradaxa is indicated for the prevention of
stroke and systemic embolism in patients with non-valvular atrial fibrillation and at least one additional risk factor for stroke.2
Protect the brain‡
Strokes shatter lives1
in non-valvular AF†
BI APR0014R_AP_0313 - 1 2013- 03- 11T09: 38: 32+11: 00
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