Answer:
The TNF inhibitors have shown dramatic efficacy in the treatment of RA. Careful studies have shown significant improvements in function, lessening the number of swollen and tender joints and a slowing of the radiographic progression of disease. These medications have been used safely and effectively with more traditional DMARDs as well. The most common toxicities [...]
Archive for the 'Rheumatology' Category
Question: How effective are the TNF inhibitors in the treatment of RA?
Wednesday, April 16th, 2008Posted in Rheumatology | No Comments »
Question: What are the newest options for treatment of RA?
Wednesday, April 16th, 2008Answer:
The newest options for the treatment of RA are anti-cytokine regimens. Three preparations (etanercept [Enbrel], infliximab [Remicade], and adalimunmab [Humira]) target TNF-α and one targets IL-1R (anakinra [Kineret]). All of these options are given parenterally and are fairly expensive. Anakinra, although proven efficacious, requires daily injections and has a slower onset of action and is [...]
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Question: Which immunosuppressive drugs are effective as DMARDs?
Wednesday, April 16th, 2008Answer:
Immunosuppressive drugs have been shown to be effective DMARDs in RA. To a large degree their use is restricted by their toxicities. Chlorambucil and cyclophosphamide are generally reserved for severe disease including the development of extra-articular features such as vasculitis. Azathioprine has been studied in RA, but its greater toxicity risk and lack of efficacy [...]
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Question: How effective are sulfasalazine and leflunomide?
Tuesday, April 15th, 2008Answer:
Sulfasalazine is an easy to use and well-tolerated medication. Some studies have shown it to be as effective as methotrexate as a DMARD. It is used more frequently in Europe than in the U.S.
Leflunomide (Arava) has been available for a number of years. It is known to inhibit pyrimidine synthesis and thereby alter T-cell function. [...]
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Question: Which DMARD is the cornerstone of treatment for RA in the U.S.?
Tuesday, April 15th, 2008Answer:
In the U.S, methotrexate remains the cornerstone of treatment for RA. Its exact mechanism of action is unclear, but its anti-folate effect contributes to its effect as a potent anti-inflammatory agent. It has a more rapid onset of action than many of the older DMARDs. Although it has many potential toxicities, most are reversible when [...]
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Question: Are antimalarial agents useful as DMARDs?
Tuesday, April 15th, 2008Answer:
Hydroxychloroquine (Plaquenil) is pretty well the uniquely used antimalarial medication in the U.S. (over chloroquine [Aralen] and quinacrine [Atabrine]). Antimalarial medications are believed to be weak, have a slow onset of action, and are generally used in mild disease or in combination with other DMARDs.
Reference: Hochberg MC (ed). Rheumatology, 3rd ed. St. Louis, Mosby, 2003
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Question: How do the effects of aspirin on platelets differ from those of other NSAIDs?
Tuesday, April 15th, 2008Answer:
NSAIDs, including aspirin, decrease platelet aggregation by inhibiting the COX. Acetylated salicylates (such as aspirin) irreversibly destroy this enzyme, whereas other NSAIDs (including nonacetylated salicylates) allow the return of normal enzyme function once the drug level has dropped. Because COX-2 does not regulate platelet aggregation, newer COX-2 NSAIDs have little effect on platelet function.
Reference: Koopman [...]
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