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Reactive arthritis
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
DMARDs: Treatment with a disease-modifying antirheumatic drug (DMARD) is indicated in patients who do not respond well to initial therapies. DMARDs are generally used in patients who have not responded adequately to at least two different NSAIDs over a total of 4 weeks and who require ongoing therapy with more than 7.5 mg prednisolone or equivalent for more than 3–6 months.
Rheumatoid Arthritic Pain
Published in Andrea Kohn Maikovich-Fong, Handbook of Psychosocial Interventions for Chronic Pain, 2019
Natasha S. DePesa, Chelsea Wiener, Jeffrey E. Cassisi
Biological factors such as disease severity and medication efficacy may influence pain experiences among patients with RA. Perhaps not surprisingly, those with greater disease severity (i.e., more inflammation and joint degeneration) often report higher levels of pain. Medication is currently the first line of treatment for patients with RA, and the availability and effectiveness of medications for RA has improved greatly over the last decade (Singh et al., 2012). Currently, the most common forms of pharmacological treatment are disease-modifying antirheumatic drugs (DMARDs such as methotrexate), usually taken in pill form; biologic agents, commonly a self-administered injection (e.g., adalimumab, etanercept); and combination therapy using both a DMARD and a biologic agent. These medications can help slow the general progression of RA, while corticosteroids (via pill or intraarticular injection) can help manage acute disease flares (Gøtzsche & Johnansen, 2009; Singh et al., 2012).
The challenge of recognising and managing inflammatory arthritis
Published in David Silver, Silver's Joint and Soft Tissue Injection, 2018
Another critical barrier can be the arrangement of a timely appointment with a specialist. The introduction of early arthritis clinics in many rheumatology departments has proven very effective at reducing this cause of delay.5 These clinics have been organised specifically for patients who have developed recent onset arthritis. They are often alongside nurse specialist clinics so that patients are diagnosed, counselled and started on disease-modifying antirheumatic drug (DMARD) medications promptly in a single visit.
First-time adverse drug reactions, survival analysis, and the share of adverse drug reactions in treatment discontinuation in real-world rheumatoid arthritis patients: a comparison of first-time treatment with adalimumab and etanercept
Published in Expert Opinion on Drug Safety, 2023
Kimberly Velthuis, Naomi T. Jessurun, Thi D.M. Nguyen, Joep Scholl, Jurriaan R.G. Jansen, Jette A. van Lint, Leanne J. Kosse, Peter M. ten Klooster, Harald E. Vonkeman
Current cornerstone drug treatment of rheumatoid arthritis (RA) consists of various disease-modifying antirheumatic drugs (DMARDs). Biological DMARDs (bDMARDs) are prescribed in patients with poor prognostic factors and/or insufficient response on conventional synthetic DMARDs (csDMARDs) [1]. Two of the most frequently prescribed bDMARDs are adalimumab (ADA) and etanercept (ETN). After starting bDMARD treatment, patients may experience various adverse drug reactions (ADRs), which may lead to reduced drug adherence and cause high burden [2,3]. ADRs are a cause of dose adjustment or, if the burden is too high, discontinuation of and switching to another treatment [2,4,5]. Hence, ADRs caused by DMARDs have been of scientific interest for years [6,7]. Thus far, little is known about time to first ADR, and the share of ADRs in causes of first-time treatment discontinuation of different bDMARDs in daily practice.
Beneficial Effect of Upadacitinib in an Adult Patient with Juvenile Idiopathic Arthritis-associated Uveitis after Unsatisfactory Response to Tofacitinib: A Case Report
Published in Ocular Immunology and Inflammation, 2023
Karoline Baquet-Walscheid, Carsten Heinz, Thomas Rath, Martin Scheel, Arnd Heiligenhaus
Uveitis associated with juvenile idiopathic arthritis (JIAU) frequently persists into adulthood and can lead a severe course, leading to vision-threatening complications.1 Systemic disease-modifying antirheumatic drug (DMARD) treatment is frequently required. According to current guidelines, patients failing initial methotrexate (MTX) treatment receive the TNF-alpha inhibitor adalimumab.2 Second-line therapeutic options encompass other TNF inhibitors or various other biologics, such as tocilizumab, abatacept, or rituximab. However, all of those substances have not been approved for uveitis diseases. The most recent development in JIA treatment was the approval of tofacitinib, a drug inhibiting janus kinase (JAK) 1 and 3, for treatment of polyarticular or extended oligoarticular JIA and juvenile PsA.3 Several case reports on the effect of tofacitinib or baricitinib, a JAK 1 and −2 inhibitor, in JIAU have been published, demonstrating the beneficial effect of these novel drugs not only on arthritis but also on associated uveitis.4,5 Currently, a phase 3 trial on baricitinib in pediatric anterior uveitis is ongoing.6 In addition to those so-called “first generation” or “unselective” JAK inhibitors, additional substances, such as upadacitinib, are available selectively targeting only one JAK isoform.7 Up to now, no data are available on the use of those in ocular inflammation.8
Targeted therapy of rheumatoid arthritis via macrophage repolarization
Published in Drug Delivery, 2021
Xu Zhou, Dandan Huang, Runkong Wang, Mingquan Wu, Liyang Zhu, Wei Peng, He Tu, Xuangeng Deng, He Zhu, Zhong Zhang, Xinming Wang, Xi Cao
Rheumatoid arthritis (RA) is a chronic autoimmune disease that is mostly characterized by chronic inflammation of the joint. The clinical symptoms include cartilage and bone damage and joint function deterioration, which eventually lead to disability. RA affects approximately 1% of the population worldwide and is more prevalent in women than in men; additionally, the affected population tends to be younger (McInnes & Schett, 2017; Tardito et al., 2019). Based on the fact that more than 90% of patients with RA could exhibit different degrees of disability within two decades of onset, causing a huge threat to the quality of life and security of RA patients, treating RA early is crucial (Emery et al., 2002). To deal with RA, current interventions mainly include medication, physiotherapy, and adjustments to lifestyle. For drug therapy, disease-modifying antirheumatic drugs (DMARDs), glucocorticoids (GCs), and nonsteroidal anti-inflammatory drugs (NSAIDs) are most commonly used to effectively improve this condition, but the long-term administration and the high-doses of these drugs may cause serious side effects. Therefore, complementary and alternative treatment options are greatly needed to improve the therapeutic effects and decrease side effects (Yuan et al., 2012; Wang et al., 2016; Ebel & O’Dell, 2021; Kapoor et al., 2021).