Antirheumatics methotrexate

The miscellaneous drugp are used to treat a variety of musculoskeletal disorders. Ffenicillamine, methotrexate (MTX), and hydroxychloroquine are used to treat rheumatoid arthritis in patients who have had an insufficient therapeutic response to or are intolerant of other antirheumatic drugp such as the sailcylates and NSAIDs. The Summary Drug Table Drug s Used to Tream Musculoskeletal Disorders provides additional information about these and other drug s. One compound, hylan G-F 20, listed in the Summary Drug Table is not used for rheumatoid arthritis, but rather, for osteoarthritis knee pain. It is a viscous, elastic... 

Methotrexate is the disease-modifying antirheumatic drug of choice because of its documented efficacy and safety profile when monitored appropriately. 

FIGURE 4-1. Algorithm for treatment of rheumatoid arthritis. (DMARD, diseasemodifying antirheumatic drug MIX, methotrexate NSAID, nonsteroidal antiinflammatory drug Rx, therapy.)... 

Methotrexate is one of the disease-modifying antirheumatic drugs, which are administered once a week. The initial dose is 7.5 mg administered once a week and the maximum dose is 15-20 mg administered once a week. 

The first-line agents in the treatment of rheumatoid arthritis are non-steroidal anti-inflammatory drugs such as diclofenac. Diclofenac and indometacin, another NSAID, tend to have similar activity hov/ever, indometacin has a higher incidence of side-effects and therefore diclofenac is more appropriate for initial treatment. Sodium aurothiomalate is classified as a disease-modifying antirheumatic drug and is used as a second-line treatment in rheumatoid arthritis, but has been superseded by methotrexate, administered v/eekly. Paracetamol is often indicated in the management of osteoarthritis. Local intra-articular injections of dexamethasone may be administered for the relief of soft-tissue inflammatory conditions. 

Anakinra (Kineret) is the first antirheumatic agent that acts by blocking the action of IL-1. This drug was recently approved for the treatment of moderately to severely active rheumatoid arthritis in adults who have not responded to therapy with one or more DMARDs. Anakinra may be used alone or in combination with DMARDs other than the TNF antagonists. Clinical trials have shown anakinra to be more effective than placebo, either alone or in conjunction with methotrexate. 

Methotrexate (Rheumatrex Dose Pack, Trexall) [Antineoplastic, Antirheumatic (DMARDs), Immunosuppressant/ Antimetabolite] WARNING Administration only by experienced healthcare provider do not use in women of childbearing age unless absolutely necessary (teratogenic) impaired elimination w/ impaired renal Fxn, ascites, pleural effusion severe myelosuppression if used w/ NSATDs hepatotox can induce lung Dz ... 

Methotrexate is also used in the treatment of rheumatoid arthritis (Chapter 36 Nonsteroidal Anti-Inflammatory Drugs, Disease-Modifying Antirheumatic Drugs, Nonopioid Analgesics, Drugs Used in Gout) and psoriasis. 

Rau R, Schleusser B, Herborn G, Karger T. Longterm combination therapy of refractory and destructive rheumatoid arthritis with methotrexate (MTX) and intramuscular gold or other disease modifying antirheumatic drugs compared to MTX monotherapy. J Rheumatol 1998 25(8) 1485-92. 

However, the rate of adverse effects associated with leflunomide was significantly lower than with methotrexate and other disease-modifying antirheumatic drugs (DMARDs) in an analysis of 40 594 patients with rheumatoid arthritis (8,51). The incidences of adverse events per 1000 patient-years were as follows ... 

Conaghan PG, Brooks P. Disease-modifying antirheumatic drugs, including methotrexate, gold, antimalarials, and D-penicillamine. Curr Opin Rheumatol 1995 7(3) 167-73. 

Disease-modifying antirheumatic drugs (DMARDs) are thought to slow disease progression and may be started with NSAIDs at the time of initial diagnosis, especially if symptoms are severe. Hydroxychloroquine is often recommended for mild arthritis and methotrexate (MTX) for moderate to severe RA. Other DMARDs (see Table VI-1-3) are used less frequently, sometimes in combination regimens for refractory cases. 

A preliminary, open-label study also demonstrated promising antirheumatic efficacy of tacrolimus at a daily dose of 2-6 mg/patient in 12 patients with severe, recalcitrant RA who had failed, on average, 5.3 DMARD and all who had failed methotrexate treatment due either to toxicities (N=5) or lack of efficacy (N=l) [75]. 

Slow-acting antirheumatic drugs Methotrexate Hydroxychloroquine, sulfasalazine Infliximab, etanercept, leflunomide, penicillamine, gold... 

Older disease-modifying antirheumatic drugs (DMARDs) used frequently in rheumatoid arthritis include hydroxychloroquine, methotrexate, steroids, and sulfasalazine. Gold salts and penicillamine may be effective but cause severe toxicity (see Chapter 36). 

Which instruction should the nurse discuss with the client diagnosed with rheumatoid arthritis who is prescribed methotrexate, a disease-modifying antirheumatic drug... 

The client with rheumatoid arthritis has been taking methotrexate, a diseasemodifying antirheumatic drug (DMARD), for 2 weeks. Which laboratory data would warrant intervention by the nurse ... 

The client with rheumatoid arthritis is prescribed the disease-modifying antirheumatic drug (DMARD) methotrexate (Rheumatrex). After 3 days, the client reports that the medication is not working. Which statement is the clinic nurse s best response ... 

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