Counseling Points - March 2008 - (Page 13)

CP Counseling Points Pharmacological and Nonpharmacological Treatment of Rheumatoid Arthritis • Because joint destruction begins within a few weeks of symptom onset in rheumatoid arthritis (RA), early diagnosis and treatment are crucial to decrease impairment of physical function and halt disease progression. A delay in therapy of as little as 3 months has been demonstrated to cause irreversible joint damage. • Treatment plans for RA includes pharmacological as well as nonpharmacological modalities, such as medications, exercise/rest, reduction of joint stress, physical and occupational therapy, and surgery. • Joint safeguards, such as resting hand splints, wrist supports, finger splints, and special shoe inserts are often recommended to decrease pain, reduce swelling, and/or prevent rheumatoid joint deformity. • Three primary classes of medications are used to treat RA: nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and disease-modifying antirheumatic drugs (DMARDs). • NSAIDs work by controlling pain and inflammation through a channel of the metabolism of arachidonic acid. • Older, traditional NSAIDs, such as aspirin, are non-selective and interact mostly with COX-1 isoenzymes. Newer NSAIDs, such as celecoxib, selectively target COX-2. • The two most common adverse reactions associated with traditional NSAIDs are ulcer and gastrointestinal bleeding. • To reduce the incidence and severity of side effects, corticosteroids are used short term, and short- or intermediate-acting compounds, such as prednisone and prednisolone, are preferred to long-acting agents, such as dexamethasone. • Side effects of corticosteroids can include water retention, elevated blood sugar, suppression of adrenal glands and the immune system, bone loss, an increased susceptibility to bacterial, viral, and fungal infections, cataracts, glaucoma, weight gain, osteoporosis, hypertension, and hyperlipidemia. • Biologic DMARDs have novel mechanisms of action and a more rapid onset of action than conventional DMARDs. • TNF antagonists adalimumab, etanercept, and infliximab have similar side effect profiles. Some of the drugs’ adverse events include infection, reactivation of hepatitis B, and disseminated tuberculosis (TB) due to reactivation of latent TB. • Biologic DMARDs abatacept, anakinra, and rituximab, are used to treat RA that is refractory to TNF antagonists and other DMARDs. • Rituximab has a unique mechanism of action that depletes CD20-expressing B-cells. • Anakinra works by retarding the biologic inflammatory activity of the cytokine IL-1. ™ 13 MARCH 2008

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Counseling Points - March 2008 Welcome Pharmacological and Nonpharmacological Treatment of Rheumatoid Arthritis

Counseling Points - March 2008

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