DMARDs disease-modifying antirheumatic

DL-CFU Dendritic cell/Langerhans cell colony forming DLE Discoid lupus erythematosus DMARD Disease-modifying antirheumatic drug... 

FIGURE 54-2. Outl ine of the management of rheumatoid arthritis. (From Guidelines for the management of rheumatoid arthritis 2002 update. Arthritis Rheum 2002 46(2) 328-346, with permission.) DMARD, disease-modifying antirheumatic drug NSAID, nonsteroidal antiinflammatory drug ... 

DMARD disease-modifying antirheumatic drug ESR erythrocyte sedimentation rate... 

CD-PC collecting duct principal cell DMARD disease modifying antirheumatic drugs... 

TDM Therapeutic Drug Monitoring DMARD, disease modifying antirheumatic drug BA, bioavailability i.v., intravenous p.o. per orale. 

BA, Bioavailability DMARD, disease modifying antirheumatic drug. 

A disease-modifying antirheumatic drug (DMARD) should be started within the first 3 months of symptom onset (Fig. 4-1). DMARDs should be used in all patients except those with limited disease. Early use of DMARDs results in a more favorable outcome and can reduce mortality. 

Rhenmatoid arthritis (RA) is a chronic systemic inflammatory arthritis that occurs in abont 1% of the population worldwide. Untreated, RA is associated with joint destruction, disability, and increased mortality (1). Early detection and therapy with disease-modifying antirheumatic drags (DMARDs) is critical in preventing these seqnelae of RA. With the recent advent of biologic DMARDs, which are effective bnt expensive therapies for RA, there has been a focns on developing methods that... 

Polyarticular-course juvenile rheumatoid arthritis (JRA) For reducing signs and symptoms of moderately to severely active polyarticular-course JRA in patients who have had an inadequate response to at least 1 disease-modifying antirheumatic drug (DMARD). 

B. Indications and use Kineret is indicated for the reduction in signs and symptoms of moderately to severely active rheumatoid arthritis in patients 18 years of age or older who have failed one or more disease-modifying antirheumatic drugs (DMARDs). Kineret can be used alone or in combination with DMARDs other than tumor necrosis factor (TNF) blocking agents. 

Another important group of agents is characterized as disease-modifying antirheumatic drugs (DMARDs). They decrease inflammation, usually improve symptoms, and slow the bone damage associated with rheumatoid arthritis. They are thought to affect more basic inflammatory mechanisms than do glucocorticoids or the NSAIDs. They may also be more toxic than those alternative medications. 

In general, disease modifying antirheumatic drugs (DMARDs) are immune modulators that are believed to restore a more normal immune environment... 

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 ... 

Cannon GW, Holden WL, Juhaeri J, Dai W, Scarazzini L, Stang P. Adverse events with disease modifying antirheumatic drugs (DMARD) a cohort study of leflunomide compared with other DMARD. J Rheumatol 2004 31(10) 1906-11. 

In a comprehensive study of 158 Japanese patients with rheumatoid arthritis, there was an obvious relation between membranous nephropathy and exposure to disease-modifying antirheumatic drugs (DMARDs) in 40 of 49 patients (231). In this study penicillamine (15%), bucillamine (67%), and gold compounds (17%) clearly predominated. 

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