Rheumatoid arthritis methotrexate for

Infliximab is administered in combination with methotrexate for rheumatoid arthritis. A dose of 3 mg/kg is administered via intravenous infusion and is repeated after 2 and 6 weeks followed by the maintenance dose every 8 weeks. The recommended dose for Crohn s disease is 5 mg/kg. The side effects associated with the administration of infliximab include acute infusion reactions (fever, chills, chest pain, hypotension and rare anaphylaxis), increased risk of infection, production... 

In 22 of 29 patients (76%) who were treated with low-pulse doses of methotrexate for rheumatoid arthritis, liver biopsy specimens showed variability in liver cell nuclear size, glycogenated nuclei, and fatty change. Occasionally there was mild portal infiltration with lymphocytes. There were no significant differences in age, duration of treatment, or cumulative dose amongst the cases. Serial increases in serum transaminases and/or alkaline phosphatase activity and development of hypoalbuminemia during treatment were indicators of development of liver disease (54). 

In a meta-analysis of 636 patients from 15 studies, who took chronic low-dose methotrexate for rheumatoid arthritis or psoriasis, the risk of liver toxicity increased with cumulative dose and heavy alcohol intake (56). 

Walker AM, Funch D, Dreyer NA, Tolman KG, Kremer JM, Alarcon GS, Lee RG, Weinblatt ME. Determinants of serious liver disease among patients receiving low-dose methotrexate for rheumatoid arthritis. Arthritis Rheum 1993 36(3) 329-35. 

Kremer JM, Alarcon GS, Lightfoot RW Jr, Willkens RE, Furst DE, Williams HJ, Dent PB, Weinblatt ME. Methotrexate for rheumatoid arthritis. Suggested guidelines for monitoring hver toxicity. American College of Rheumatology. Arthritis Rheum 1994 37(3) 316-28. 

Hayem G, Meyer O, Kahn MF. Listeria monocytogenes infection in a patient treated with methotrexate for rheumatoid arthritis. J Rheumatol 1996 23(l) 198-9. 

Lyon CC, Thompson D. Herpes zoster encephalomyelitis associated with low dose methotrexate for rheumatoid arthritis. J Rheumatol 1997 24(3) 589-91. 

SaUoum E, Cooper DL, Howe G, Lacy J, TaUini G, Crouch J, Schultz M, Murren J. Spontaneous regression of lymphoprolrferative disorders in patients treated with methotrexate for rheumatoid arthritis and other rheumatic diseases. J Qrn Oncol 1996 14(6) 1943-9. 

Inhibitors of IL-1 Anakinra inhibits the activity of IL-1. It is licensed for use in combination with methotrexate for rheumatoid arthritis that is unresponsive to methotrexate alone. Anakinra is given by sub-cutaneous injection once weekly. National... 

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... 

For rheumatoid arthritis, the pharmacogenomics of three major diseasemodifying antirhenmatic drags (methotrexate, azathioprine, and sulfasalazine) and one class of biologic antirhenmatic drags (the tumor necrosis factor antagonists) are discnssed in detail. 

A 43-year-old woman developed cavitary lung tuberculosis after she received methotrexate and glucocorticoid pulse therapy for rheumatoid arthritis (321). 

Morgan SL, et al. Folic acid supplementation prevents deficient blood folate levels and hyperhomocysteinemia during longterm,low dose methotrexate therapy for rheumatoid arthritis implications for cardiovascular disease prevention. J Rheumatol 1998 25(3) 44l-446. 

Methotrexate is used widely as a DMARD for rheumatoid arthritis, psoriatic arthritis, and for its steroid-sparing effects in many other conditions, especially if azathioprine is not tolerated. In high dose, with folinic acid rescue, methotrexate is used to treat solid and haematological malignancies (see p. 612). Low dose methotrexate slows the progression of rheumatoid arthritis. The evidence for a true disease-modifying effect on psoriatic arthritis is less definite, but methotrexate is often preferred to other DMARDs for its beneficial effect on the skin lesions. 

Morgan SL, Baggott JE, Vaughn WH, Austm JS, Veitch TA, Lee JY, Koopman WJ, Krumdieck CL, Alarcon GS. Supplementation with folic acid during methotrexate therapy for rheumatoid arthritis. A doubleblind, placebo-controlled trial. Ann Intern Med 1994 121(11) 833-41. 

Schnabel A, Dalhoff K, Bauerfemd S, Barth J, Gross WL. Sustained cough in methotrexate therapy for rheumatoid arthritis. Clin Rheumatol 1996 15(3) 277-82. 

Worthley SG, McNeil JD. Leukoencephalopathy in a patient taking low dose oral methotrexate therapy for rheumatoid arthritis. J Rheumatol 1995 22(2) 335-7. 

Kerstens PJ, Boerbooms AM, Jeurissen ME, Fast JH, Assmann KJ, van de Putte LB. Accelerated nodulosis during low dose methotrexate therapy for rheumatoid arthritis. An analysis of ten cases. J Rheumatol 1992 19(6) 867-71. 

Combe B, Didry C, Gutierrez M, Anaya JM, Sany J. Accelerated nodulosis and systemic manifestations during methotrexate therapy for rheumatoid arthritis. Eur J Med 1993 2(3) 153-6. 

Fatal bone marrow suppression has been reported in an 82-year-old woman who took methotrexate 7.5 mg/ week for one year for rheumatoid arthritis without hematological problems. She was given trimethoprim 100 mg/day at first and later 200 mg/day. One week later, she developed severe pancytopenia. The bone marrow failed to recover despite treatment with folinic acid and G-CSF, and she died of bronchopneumonia. 

The prognosis of methotrexate-induced pulmonary toxicity is good, with a 1% or less mortality rate. Pulmonary toxicity has followed intrathecal as well as oral administration and has occurred after single doses as well as long-term daily and intermittent administration. Pneumonitis has been reported to occur up to 4 weeks following discontinuation of therapy. Numerous anecdotal reports have claimed dramatic benefit from corticosteroid therapy. It is unknown whether intermittent (weekly) dosing, as is done for rheumatoid arthritis, decreases the risk of methotrexate-induced pulmonary toxicity because pneumonitis has occurred with this form of dosing. 

Because it is a folic acid antagonist, methotrexate can induce a folic acid deficiency. This deficiency is thought to be partly responsible for methotrexate toxicity, and supplementation with folic acid has been shown to alleviate some adverse effects. Addition of folic acid to a methotrexate regimen for rheumatoid arthritis does not compromise drug efficacy. ... 

The decline in the number of reports of parenter-ally administered gold-induced nephropathy may indicate that the dose of gold salts used per injection is decreased and intervals between injections are being extended to prevent adverse reactions. Furthermore, introduction of methotrexate therapy for rheumatoid arthritis has contributed to decreased reliance on gold salts. 

A study in 39 patients who had recently started treatment with methotrexate 7.5 mg weekly found that patients with a self reported high caffeine intake (more than 180 mg eaffeine per day, 13 patients) had less relief in their symptoms of rheumatoid arthritis, sueh as swollen joints and joint pain, and smaller reductions from baseline in their erythrocyte sedimentation rate (ESR), a marker for inflammation, than patients with a low eaffeine intake (less than 120 mg caffeine per day, 13 patients). A survey of 91 patients taking methotrexate 5 to 15 mg weekly for rheumatoid arthritis found that those who were regular eoffee drinkers (more than 7 eups a week) had a higher rate of methotrexate diseontinuation (due to treatment failure in 80% of cases). ... 

Carmichael SJ, Beal J, Day RO, Tett SE. Combination therapy with methotrexate and hydroxychloroquine for rheumatoid arthritis increases exposure to methotrexate. J Rheumatol (2002) 29, 2077-83. 

A 57 year-old woman who had been treated for several years with daily doses of dielofenae 150 mg, atenolol 50 mg and triamterene with hydrochlorothiazide 50/25 mg, for rheumatoid arthritis and hypertension, additionally started treatment with methotrexate 5 mg weekly. After 2 months she was admitted to hospital with pancytopenia, extensive mu-eosal uleeration and renal impairment. The authors point out that triamterene is structurally similar to folate and has anti-folate activity, which may therefore have been additive with the effects of methotrexate, but the diclofenac may also have contributed (see Methotrexate + NSAIDs , p.649). In 1998, the manufacturer noted there were two other reports of pancytopenia in patients taking methotrexate and triamterene, but again the patients were also taking NSAIDs. ... 

Folic acid or folinic acid are sometimes added to low-dose methotrexate treatment for rheumatoid arthritis or psoriasis to reduce adverse effects. Folinic acid is frequently used as an antidote to high-dose methotrexate in cancer therapy. Patients taking methotrexate should avoid the inadvertent use of folates in multivitamin preparations. 

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