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    Dmards

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    sumaiya jalal
    The document discusses disease-modifying antirheumatic drugs (DMARDs) for treating rheumatoid arthritis. It provides details on common conventional DMARDs like methotrexate, hydroxychloroquine, leflunomide, and sulfasalazine. It notes that DMARDs usually take longer to work than other drugs. The choice of DMARD depends on factors like other medical conditions, costs, and administration. DMARDs may be prescribed alone or in combinations, and dosages are adjusted over time based on symptoms. Monitoring of patients on DMARDs includes vaccines, cancer risks, and dose changes for kidney problems. DMARDs are also used to treat juvenile arthritis and diabetes-related arthritis.

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    Dmards

    Uploaded by

    sumaiya jalal
    40 views4 pages
    The document discusses disease-modifying antirheumatic drugs (DMARDs) for treating rheumatoid arthritis. It provides details on common conventional DMARDs like methotrexate, hydroxychloroquine, leflunomide, and sulfasalazine. It notes that DMARDs usually take longer to work than other drugs. The choice of DMARD depends on factors like other medical conditions, costs, and administration. DMARDs may be prescribed alone or in combinations, and dosages are adjusted over time based on symptoms. Monitoring of patients on DMARDs includes vaccines, cancer risks, and dose changes for kidney problems. DMARDs are also used to treat juvenile arthritis and diabetes-related arthritis.

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    The document discusses disease-modifying antirheumatic drugs (DMARDs) for treating rheumatoid arthritis. It provides details on common conventional DMARDs like methotrexate, hydroxychloroquine, leflunomide, and sulfasalazine. It notes that DMARDs usually take longer to work than other drugs. The choice of DMARD depends on factors like other medical conditions, costs, and administration. DMARDs may be prescribed alone or in combinations, and dosages are adjusted over time based on symptoms. Monitoring of patients on DMARDs includes vaccines, cancer risks, and dose changes for kidney problems. DMARDs are also used to treat juvenile arthritis and diabetes-related arthritis.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    40 views4 pages

    Dmards

    Uploaded by

    sumaiya jalal
    The document discusses disease-modifying antirheumatic drugs (DMARDs) for treating rheumatoid arthritis. It provides details on common conventional DMARDs like methotrexate, hydroxychloroquine, leflunomide, and sulfasalazine. It notes that DMARDs usually take longer to work than other drugs. The choice of DMARD depends on factors like other medical conditions, costs, and administration. DMARDs may be prescribed alone or in combinations, and dosages are adjusted over time based on symptoms. Monitoring of patients on DMARDs includes vaccines, cancer risks, and dose changes for kidney problems. DMARDs are also used to treat juvenile arthritis and diabetes-related arthritis.

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    © All Rights Reserved
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    Download as docx, pdf, or txt
    of 4

    including connective tissue diseases such as systemic sclerosis, systemic lupus

    We will discuss some of the common conventional DMARDs

    Methotrexate — should be taken with folic acid or Leucovorin


    Live vaccines cannot be given to anyone already taking methotrexate.
    They should also limit alcohol use because of the increased risk of liver injury with this
    combination.
    Women should not become pregnant while taking methotrexate.

    Hydroxychloroquine It works by inhibiting

    Leflunomide It basically works by blocking

    How long to DMARDs take to work Conventional DMARDs usually take longer

    CHOOSING BETWEEN DMARDs

    other medical conditions, of the patient

    personal preference. (cost of DMARD, how often it’s taken, administration etc).

    How are DMARDs prescribed?


    If there is mild to moderate disease the physician may start with a traditional DMARD.
    If the symptoms don’t improve enough after a few months, he may increase the dosage or
    switch to a different DMARD or add one or more DMARDs including a biologic DMARD to
    the treatment plan.
    In some cases, one DMARD is used. In others, combinations may be recommended. So the
    patient tries different medicines or combinations to find one that works best and has the
    fewest side effects.

    Monitoring

     All recommended vaccines should be taken before starting DMARDs and influenza
    vaccine to be taken each year.

     The risk of herpes zoster (or shingles)

     Since many of these DMARDs require dose adjustment in renal insufficiency,


     For all the biologic DMARDS

    DMARDs in Diabetes mellitus

     The most likely connection between type 2 diabetes and Rheumatoid arthritis (RA)
    involves
     If you have one you are likely to have another autoimmune disorder
    Methotrexate

    Severe bone marrow suppression and aplastic anemia have been reported with
    concomitant administration of methotrexate (usually in high dosage) along with
    some NSAIDs.

    Juvenile idiopathic arthritis  Oral, SUBQ: Initial: 0.5 mg/kg once weekly;


    maximum initial dose: 15 mg/dose;

    if symptoms worsen or are unchanged after 4 weeks, may increase to SUBQ: 1


    mg/kg; maximum dose: 25 mg/dose

    10-15 mg/m2 per week, up to a maximum of 25 mg per week.

    Low dose methotrexate therapy of RA and psoriasis with dose of 7.5–25 mg/week
    versus high dose methotrexate therapy of 1–5 g/week in cancer.

    Increases the adenosine concentration at the site of inflammation.

    Folic acid reduces the risk of hepatotoxicity and gastrointestinal side effects.

    Sulfasalazine

    Juvenile idiopathic arthritis: 6 -16 years: Oral: 30 to 50 mg/kg/day in 2 divided


    doses; maximum daily dose: 2,000 mg/day

    Hydroxychloroquine

    Juvenile dermatomyositis: Children and Adolescents: Maximum of 5


    mg/kg/day to mitigate risk of retinal toxicity in 1 to 2 divided doses. maximum
    daily dose: 400 mg/day.

    Leflunomide 10-20 mg once daily

    Certolizumab Pediatric: Malignancies have been reported among children and


    adolescents receiving TNF-blocking agents.

    Cyclophosphamide urinary tract and bladder cancer

    Biologics in pediatrics: Etanercept, Adalimumab, Infliximab, Anakinra, tocilizumab,


    Abatacept, rituximab
    Not used in pediatrics: Certolizumab, apremilast, baricitinib (only tofacitinib used)

    Adalimumab 10-40 mg every other week in JIA

    Anakinra JIA: Children and Adolescents: SubQ: Initial: 1 to 2 mg/kg/dose once


    daily; maximum initial dose: 100 mg;

    if no response, may titrate typically at 2-week intervals by doubling dose up to 4


    mg/kg/dose once daily; maximum dose: 200 mg

    Rheumatoid arthritis: Adolescents ≥18 years: SubQ: 100 mg once daily

    In hospitalized patients

    Tocilizumab

    (Given with systemic corticosteroids like dexamethasone)

    Children ≥2 years and Adolescents:

    <30 kg: IV: 12 mg/kg/dose once.

    ≥30 kg: IV: 8 mg/kg/dose once; maximum: 800 mg/dose.

    Baricitinib

    Children 2 to <9 years: Oral: 2 mg once daily for 14 days or until hospital
    discharge

    Children ≥9 years and Adolescents: Oral: 4 mg once daily for 14 days or until
    hospital discharge

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