Rheumatoid arthritis adverse effects

Chloroquine is a 4-aminoquinoline used in the treatment and prophylaxis of malaria and hepatic amebiasis, as well as rheumatoid arthritis. Adverse effects are generally less common and less severe. Frequent effects include headache, GI disturbances, and diarrhea. Large doses may cause blurred vision and difficulty focusing. A common adverse effect on the eye is retinopathy. Parenteral therapy with chloroquine can be hazardous, and rapid intravenous injections may result in cardiovascular toxicity. Acute overdose is extremely dangerous death may occur within a few hours. Chloroquine should be used cautiously in patients with liver and kidney impairment. Chloroquine may aggravate the condition of myasthenia... 

PjTitinol is a sulfhydryl-containmg compound, a dimer of 5-thiopjTidoxine. It was used from 1961 onwards as a psychostimulant of doubtful efficacy, but apparently without adverse effects, and then largely abandoned. When it was re-introduced in some countries for rheumatoid arthritis, adverse effects were registered in 25% of patients. 

Berkun, Y., Levartovsky, D., Rubinow, A., et al. (2004) Methotrexate related adverse effects in patients with rheumatoid arthritis are associated with the A1298C polymorphism of the MTHFR gene. Annals of the Rheumatic Diseases. 63, 227-231. 

Tanaka, E., Taniguchi, A., Urano, W., et al. (2002) Adverse effects of sulfasalazine in patients with rheumatoid arthritis are associated with diplotype configuration at the iV-acetyltransferase 2 gene. Journal of Rheumatology. 29, 2492-2499. 

Children Patients as young as 6 months of age have received Sandimmune v / Vr no unusual adverse effects. Transplant recipients as young as 1 year of age have received Neoral or Gengrraf with no unusual adverse effects. The safety and efficacy of Neoral or Gengraf treatment in children younger than 18 years of age with juvenile rheumatoid arthritis or psoriasis have not been established. 

The arylpropionic acid derivatives are useful for the treatment of rheumatoid arthritis and osteoarthritis, for reduction of mild to moderate pain and fever, and for pain associated with dysmenorrhea. Side effects of the drugs are similar to but less severe than those described for the salicylates. Those who are sensitive to salicylates also may be sensitive to and have adverse reactions when taking ibuprofen and related drugs. Acute hypersensitivity to ibuprofen has been reported in patients with lupus. The hypersensitivity reaction to sulindac can be fatal. The use of sulindac has also been linked to cases of acute pancreatitis. The use of dimethylsulfoxide (DMSO) topically in combination with sulindac has been reported to induce severe neuropathies. The concurrent use of ibuprofen with aspirin reduces the antiinflammatory effects of both drugs. Ibuprofen is contraindicated in patients with aspirin sensitivity leading to bronchiolar constriction and in patients with an-gioedema. As with all NSAIDs, renal and liver function should be normal for adequate clearance of the drugs. 

Etodolac (Lodine) is indicated for the treatment of osteoarthritis, rheumatoid arthritis, and acute pain. It inhibits COX-2 with slightly more selectivity than COX-1 and therefore produces less GI toxicity than many other NSAIDs. Common adverse effects include skin rashes and CNS effects. 

Flurbiprofen (Ansaid) is indicated for the treatment of rheumatoid arthritis and osteoarthritis. Its half-life, longer than that of many of the NSAIDs, allows for twice daily dosing. The most common adverse effects of flurbiprofen are similar to those of the other acidic NSAIDs. Flurbiprofen inhibits both COX isoforms about equally. 

Oxaprozin (Daypro) is approved for the treatment of osteoarthritis and rheumatoid arthritis. Its long half-life allows for once daily dosing. The most frequently reported adverse effects of this drug are nausea, vomiting, and dyspepsia. 

Meloxicam (Mobic), recently introduced for the treatment of osteoarthritis, is also used for rheumatoid arthritis and certain acute conditions. Although meloxicam is sometimes reported to be a selective COX-2 inhibitor, it is considerably less selective than celecoxib or rofecoxib. Its adverse effects are similar to those of piroxicam and other NSAIDs however, the frequency of GI side effects is lower for meloxicam than for piroxicam and several other NSAIDs. 

Leflunomide (Arava) is an isoxazole derivative approved for the treatment of rheumatoid arthritis in 1998. Limited data suggest that it is comparable in efficacy to sulfasalazine and produces fewer adverse effects. It has a faster onset of action (4 weeks) than other DMARDs. 

Hydroxychloroquine (Plaquenil), like chloroquine, is a 4-aminoquinoline derivative used for the suppressive and acute treatment of malaria. It also has been used for rheumatoid arthritis and discoid and systemic lupus erythematosus. Hydroxychloroquine has not been proved to be more effective than chloroquine. Adverse reactions associated with its use are similar to those described for chloroquine. The drug should not be used in patients with psoriasis or porphyria, since it may exacerbate these conditions. 

It has become apparent that reduction in the dose of the constituents of oral contraceptives has markedly reduced mild and severe adverse effects, providing a relatively safe and convenient method of contraception for many young women. Treatment with oral contraceptives has also been shown to be associated with many benefits unrelated to contraception. These include a reduced risk of ovarian cysts, ovarian and endometrial cancer, and benign breast disease. There is a lower incidence of ectopic pregnancy. Iron deficiency and rheumatoid arthritis are less common, and premenstrual symptoms, dysmenorrhea, endometriosis, acne, and hirsutism may be ameliorated with their use. 

Penicillamine is used chiefly for treatment of poisoning with copper or to prevent copper accumulation, as in Wilson s disease (hepatolenticular degeneration). It is also used occasionally in the treatment of severe rheumatoid arthritis (see Chapter 36). Its ability to increase urinary excretion of lead and mercury had occasioned its use in outpatient treatment for intoxication with these metals, but succimer, with its stronger metal-mobilizing capacity and lower adverse-effect profile, has generally replaced penicillamine for these purposes. 

Clinical use Fenoprofen (Gruber, 1976 Brogden et al., 1977) is used as its calcium salt dihydrate in the treatment of rheumatoid arthritis and osteoarthritis at a daily dose of 1.2-3.0 g. The drug is rapidly absorbed and excreted with a plasma half-life of about 3 h despite being extensively bound (99%) to plasma protein. Fenoprofen is well tolerated, with dyspepsia being the main adverse effect. 

Chloroquine and related antimalarials are effective in rheumatoid arthritis and lupus erythematosus, but their mode of action is not known. The anthelmintic drug levamisole (186) is also effective but adverse effects limit its use. 

A 74-year-old woman with seronegative rheumatoid arthritis was given sulfasalazine followed by methotrexate, both of which were withdrawn because of adverse effects. She also took prednisone 10 mg/day. She developed acute abdominal pain and fever (38.7° C) with no chills. Her serum amylase was 269 IU/1, serum lipase... 

There have been reviews of the mechanisms and adverse effects of glucocorticoids in rheumatoid arthritis (205) and the pathogenesis, diagnosis, and treatment of glucocorticoid-induced osteoporosis in patients with pulmonary diseases (206). Several mechanisms underlie the effect of glucocorticoids on bone, both biochemical and cellular. Effects on calcium are ... 

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