DMARDs in the Management of Rheumatoid Arthritis: Difference between revisions
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<u>Introduction</u> | <u>Introduction</u> | ||
DMARDs are important in the prevention of joint deformities and injuries that can occur in RA. In general, | DMARDs are important in the prevention of joint deformities and injuries that can occur in RA. In general, block inflammation by interfering with the cellular signaling cascade (Benjamin, 2018). According to Smolen et al. (2014), therapy with DMARDs should be started as soon as diagnosis of RA is made. While there are several different types of DMARDs that can be utilized, Hydroxychloroquine (HCQ) and Methotrexate (MTX) a few of the most commonly used drugs (Singh et al., 2012). | ||
<u>Mechanisms of Action</u> | <u>Mechanisms of Action</u> | ||
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MTX is an immunomodulatory compound. It interferes with DNA synthesis via various mechanisms such as reducing neutrophil adhesion and pyrimidine supply in dividing cells. In addition, MTX inhibits gene expression and cell-mediated immunity in the body (Benjamin, 2018). | MTX is an immunomodulatory compound. It interferes with DNA synthesis via various mechanisms such as reducing neutrophil adhesion and pyrimidine supply in dividing cells. In addition, MTX inhibits gene expression and cell-mediated immunity in the body (Benjamin, 2018). | ||
<u>Dosing</u> | |||
DMARDs can be administered orally or intravenously (Benjamin, 2018). The half-lives of these drugs range from 3 hours to 14-28 days. The elimination and removal processes for MTX and SSZ occurs in the kidneys, while HCQ is partially metabolized and unchanged by the liver. | |||
<u>Adverse Effects</u> | <u>Adverse Effects</u> | ||
Revision as of 05:21, 30 November 2018
TRADITIONAL DMARDs[edit | edit source]
Introduction
DMARDs are important in the prevention of joint deformities and injuries that can occur in RA. In general, block inflammation by interfering with the cellular signaling cascade (Benjamin, 2018). According to Smolen et al. (2014), therapy with DMARDs should be started as soon as diagnosis of RA is made. While there are several different types of DMARDs that can be utilized, Hydroxychloroquine (HCQ) and Methotrexate (MTX) a few of the most commonly used drugs (Singh et al., 2012).
Mechanisms of Action
HCQ increases pH in cells, which alters protein degradation and assembles macromolecules in the cell, which results in down-regulation of the immune system.
MTX is an immunomodulatory compound. It interferes with DNA synthesis via various mechanisms such as reducing neutrophil adhesion and pyrimidine supply in dividing cells. In addition, MTX inhibits gene expression and cell-mediated immunity in the body (Benjamin, 2018).
Dosing
DMARDs can be administered orally or intravenously (Benjamin, 2018). The half-lives of these drugs range from 3 hours to 14-28 days. The elimination and removal processes for MTX and SSZ occurs in the kidneys, while HCQ is partially metabolized and unchanged by the liver.
Adverse Effects
Common adverse effects of all DMARDs include headache, nausea, and vomiting. More specifically, HCQ can induce visual disturbances, abdominal cramps, and peripheral neuritis. MTX can cause arachnoiditis, stomatitis, and nephropathy. Traditional DMARDs also pose an increased risk of cardiovascular issues and bDMARDs should be used in patients with a preexisting cardiovascular condition (Solomon et al., 2013).
PT Implications
The PT should be aware of seizures, skin irritations, gastrointestinal (GI) symptoms, and blood pressure issues when treating a patient receiving DMARDs. In addition, assessing pulmonary function and back pain is of utmost importance as they can be indications that the patient may be in danger of drug toxicity. If the patient presents with any abnormalities in vitals or metabolic outcome measures these adverse signs and symptoms should be appropriately noted and relayed to the primary physician (Ciccone, 2013).
