Arthralgia, treatment

The treatment goals for withdrawal from ethanol, cocaine/ amphetamines, and opioids include (1) a determination if pharmacologic treatment of withdrawal symptoms is necessary, (2) management of medical manifestations of withdrawal such as hypertension, seizures, arthralgias, and nausea, and (3) referral to the appropriate program for substance abuse treatment. 

Children treated with GH replacement therapy rarely experience significant adverse effects, whereas adults are more susceptible to dose-related adverse effects. Treatment with GH may mask underlying hypothyroidism. GH-induced symptoms, such as edema, arthralgia, myalgia, and carpal tunnel syndrome, are common and necessitate dose reductions in up to 40% of adults. Benign increases in intracranial pressure may occur with GH therapy and generally are reversible with discontinuation of treatment. Often, GH therapy can be restarted with smaller doses without symptom recurrence. 

Anastrozole is a selective nonsteroidal aromatase inhibitor that lowers estrogen levels. The pharmacokinetics of anastrozole demonstrate good absorption, with hepatic metabolism the primary route of elimination and only 10% excreted unchanged by the kidney. The elimination half-life is approximately 50 hours. Anastrozole is used for the adjuvant treatment of postmenopausal women with hormone-positive breast cancer and in breast cancer patients who have had disease progression following tamoxifen. Side effects include hot flashes, arthralgias, osteoporosis/bone fractures, and thrombophlebitis. 

Letrozole is another selective aromatase that inhibits the conversion of androgens to estrogen. Maximum plasma concentrations occur 1 hour after oral dosing concomitant food has not been shown to have an effect on the extent of absorption of letrazole. The terminal half-life is approximately 2 days. Letrozole is used in the treatment of postmenopausal women with hormone-receptor-positive or unknown advanced breast cancer. Side effects include bone pain, hot flushes, back pain, nausea, arthralgia, osteoporosis/bone fractures, and dyspnea. 

The majority of patients treated for primary and secondary syphilis experience the Jarisch-Herxheimer reaction after treatment, characterized by flu-like symptoms such as transient headache, fever, chills, malaise, arthralgia, myalgia, tachypnea, peripheral vasodilation, and aggravation of syphilitic lesions. 

As analgesic-antipyretic Salicylates are effective in the treatment of mild to moderate types of pain. They are used in the treatment of headache, bodyache, arthralgias, neuralgias and dysmenorrhoea. They are also effective in fever of any origin. 

Quinupristin-dalfopristin is approved for treatment of infections caused by staphylococci or by vancomycin-resistant strains of E faecium, but not E faecalis, which is intrinsically resistant probably because of an efflux-type resistance mechanism. The principal toxicities are infusion-related events, such as pain at the infusion site, and an arthralgia-myalgia syndrome. 

In a retrospective review of 497 patients taking propylthiouracil for hyperthyroidism, clinically overt hepatitis developed in six patients at 12-49 days after starting the drug (50). Jaundice and itching were present in five, fever in two, rash in two, and arthralgia in one. Serum bilirubin, alanine transaminase, and alkaline phosphatase were increased in five, four, and six patients respectively. The type of hepatic injury was cholestatic in three, hepatocellular in one, and mixed in two. There were no differences in age, sex, drug dose, or serum thyroid hormone concentrations at time of diagnosis in those with hepatic injury compared with those without. Liver function normalized in all patients at 16-145 days after withdrawal of propylthiouracil. In addition to these cases of overt liver injury, 14% of the cohort had mild asymptomatic liver enzyme rises at a mean of 75 days after the start of treatment. 

Parathyroid hormone has potent anabolic effects on the skeleton if given intermittently being used in clinical trials. Initial concerns about the development of osteosarcoma in rats after prolonged treatment with high doses of parathyroid hormone have not been confirmed in human trials, but surveillance continues (8). In one study there was a mild increase in creatinine, which was thought not to have clinical significance (9). Mild nausea (10) and arthralgia (10,11) have also been reported. 

The precise testing required to diagnose GH deficiency is controversial. Treatment of GH-deficient adults can cause increased lean body mass and bone density, decreased fat mass, increased exercise tolerance, and an improved sense of well-being. Adverse effects often include arthralgias and fluid retention. 

An antibody directed at the murine epitope of infliximab may develop in patients. A delayed infusion reaction, which occurs 1-2 weeks after infusion, develops in approximately 5% patients who are re-treated with infliximab. Delayed infusion reaction is more common in patients with circulating anti-infliximab antibodies (20-30% of those getting multiple infusions) than in those without the antibodies. These reactions consist of myalgia arthralgia fever rash urticaria and facial, hand, and lip edema. Delayed reactions respond to symptomatic treatment with antihistamines or corticosteroids. Positive antinuclear antibodies (ANA) and anti-dsDNA develop in a small number of patients. Development of a lupus-like syndrome has been reported that resolved after discontinuation of the drug. 

Two cases of serum sickness-like reactions have been reported in association with amfebutamone when used as an aid to smoking cessation (15,16). Both patients developed localized swellings of the fingers and hands, urticaria, and arthralgia. In both cases treatment with antihistamines and corticosteroids produced rapid relief of symptoms. 

Adverse effects include gastrointestinal upset cind allergic reactions (rash, pruritus, arthralgia, photosensitivity and anaphylaxis). CNS effects may develop with dizziness, headache and confusion, and are sufficient to require cautioning the patient against driving a motor vehicle. Convulsions have occurred during treatment (avoid or use with... 

Adverse effects include hyperuricaemia and arthralgia, which is relatively frequent with daily but less so with intermittent dosing and, unlike gout, affects both large and small joints. Pyrazinoic acid, the principal metabolite of pyrazinamide, inhibits renal tubular secretion of urate. Symptomatic treatment with an NSAID is usually sufficient and it is rarely necessary to discontinue pyrazinamide because of arthralgia. Hepatitis, which was particularly associated with high doses, is not a problem with modern short-course schedules. Sideroblastic anaemia and urticaria also occur. 

Nifurtimox is a nitrofuran derivative. Adverse effects include anorexia, nausea, vomiting, gastric pain, insomnia, headache, vertigo, excitability, myalgia, arthralgia and convulsions. Peripheral neuropathy may necessitate stopping treatment. 

In 20-25% of cases, side effects are observed, depending mainly on the dose (hypersensitivity reactions, aphthous lesions, arthralgia, nausea, fever). All in all, treatment of Wilson s disease with penicillamine is considered to be successful and safe. If jrenicill-amine is not well tolerated or if serious side effects are observed (e.g. kidney or bone-marrow damage, polyneuropathy, pemphigus), treatment must be discontinued. Penicillamine usually causes pyridoxin deficiency, so that substitution (25—40 mg/day) is recommended, particularly as chronic liver damage also leads to vitamin Bg deficiency. If necessary, electrolytes and trace elements also have to be substituted. 

Most common adverse effects in controlled trials include injection site reactions, vasodilatation, chest pain, asthenia, infection, pain, nausea, arthralgia, anxiety, and hypertonia. About 10% of patients experience an immediate post-injection reaction (flushing, chest pain, palpitations, anxiety, dyspnea, throat constriction, and urticaria). The symptoms are transient and self-limited, and usually do not require specific treatment. Transient chest pain was noted in 21% of Copaxone patients versus 11% in the placebo group with no long-term sequelae. Unlike therapy with the IFNps, glatiramer acetate is not associated with flu-like symptoms. 

There are also reports of remission of lupus-like syndrome without recurrence in patients in whom acecainide has been used as a replacement for procainamide (8-10). Furthermore, patients in whom procainamide has previously caused a lupus-like syndrome have been reported not to suffer from the syndrome on subsequent long-term treatment with acecainide (8). However, one patient suffered mild arthralgia while taking acecainide, having had a more severe arthropathy while taking procainamide (8). 

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