When should a patient with RA be started on a DMARD? Once the diagnosis of RA is established, all patients (with rare exception) should begin DMARD therapy. Bone erosions and joint space narrowing develop within the first 2 years of disease in most patients and are progressive from that point onward. Therefore, early, aggressive treatment …
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How quickly can traditional non bDMARDs be expected to work? Most non-bDMARDs take several months (3–6 months) to achieve a significant response. It is important to educate patients about this time frame of response so they are not discouraged when results are not seen immediately.
DMARD Because there is no cure for most rheumatic diseases such as RA or systemic lupus erythematosus (SLE), the goal of treatment is to put the disease into remission. Drugs having some ability to do this are known as DMARDs. To be designated a DMARD, a drug must change the course of the disease for …
Systemic Antirheumatic Drugs 1. Choice of disease-modifying antirheumatic drug (DMARD) therapy is based on disease severity, comorbidities, and fertility plans. 2. Hydroxychloroquine (HCQ) or sulfasalazine (SSZ) monotherapy is best used for mild rheumatoid arthritis (RA). 3. Methotrexate (MTX) is the most effective DMARD for RA and often the anchor drug for all combination therapies. 4. Combination DMARD therapy is …
How might a postinjection flare be distinguished from infection after a Glucocorticoids injection? Postinjection flares occur in 1% to 2% of patients receiving GC injections and are most likely to occur with use of least soluble (i.e., longest-acting) GC preparations. Injections of the lateral epicondyle of the elbow are particularly prone to this complication. The …
concerning problems and sequelae that may occur from Glucocorticoids injections • Infection (1 in 50,000 injections). • Skin hypopigmentation. • Steroid crystal-induced synovitis (postinjection flare; 2%). • Subcutaneous tissue atrophy. • Tendon rupture (never inject Achilles tendon area). • Osteonecrosis (rare). • Erythroderma.
Is there an optimal amount of Glucocorticoids that should be injected into a joint bursa or tendon sheath? It is generally recommended that short-acting or longer-acting GCs be injected into tendon sheaths because they are more soluble and cause less soft tissue atrophy or chance of tendon rupture. The longest-acting, least-soluble GC preparations are typically …