Drugs

How is thalidomide used in the treatment of rheumatic diseases? Thalidomide (Thalomid) has antiinflammatory, immunomodulatory, and antiangiogenic properties. Due to its side effects, it is currently rarely used for rheumatic illness. A major effect may be its ability to reduce tumor necrosis factor-α production by 40%. It is not immunosuppressive and has not been associated with …

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What are the definitions for improvement in RA treatment trials? What radiographic scoring system is most often used to measure radiographic progression in RA trials? An American College of Rheumatology (ACR) study group determined that improvement for clinical trial patients with RA should be defined as: Required: ≥20% improvement in tender joint count and ≥20% improvement in …

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What are the major toxicities of dapsone? All patients treated with dapsone will have some degree of hemolysis and methemoglobinemia and should be thus supplemented with 1 mg of folate daily. Patients with G6PD deficiency will have severe hemolysis, so all patients should be screened, particularly those of Mediterranean or African descent. The hemolysis is …

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How is dapsone used in the treatment of rheumatic diseases? Dapsone is a sulfone. It is poorly water-soluble, poorly absorbed through the GI tract, and metabolized by the liver. It is used as an antimicrobial agent for leprosy treatment. However, it also has antiinflammatory effects and is particularly useful in dermatoses involving polymorphonuclear leukocytes. It is …

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Should patients on immunosuppressive medications be vaccinated? Yes. However, depending on the medication and dose, there are special considerations. It is important to know if the vaccine is live or inactivated. Patients on prednisone or on immunosuppressive medications can receive any of the inactivated vaccines. They can receive these vaccinations without an increased chance of …

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Can combinations of two or more DMARDs be used in the treatment of RA? Yes. The role of combination DMARD therapy in the treatment of RA continues to evolve. With the addition of new medications, more therapeutic combinations are possible than ever before. Most clinical trials of combination therapy with DMARDs have included MTX. Several …

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How is minocycline used for Rheumatoid Arthritis? Minocycline is a tetracycline antibiotic that has been shown to reduce disease activity in RA. In clinical practice, it is used more in mild disease and has the benefit of not being immunosuppressant (as such it can be a good choice for those with comorbidities such as chronic obstructive …

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