Rheumatoid arthritis monitoring

The first human kidney and bone marrow transplants using cyclosporine were reported in 1978. Oral or intravenous cyclosporine is an immunosuppressant for transplantation of these and other organs and investigations are underway for its possible use in a variety of autoimmune diseases including rheumatoid arthritis, severe psoriasis, and Crohn s disease. Dose-dependent nephrotoxicity (261—264) remains the primary limitation of the dmg and necessitates close monitoring of patients, including measurement of dmg levels in blood. Cyclosporine research has been reviewed (265—274). 

Recent applications of HPAEC-PAD are many and varied. A representative list includes quantitation of polyglucose metabolites in plasma of dialysis patients,148 analysis of heat-treated milk,149 carbohydrate content in lipopolysaccharides,150 phosphorylated sugars in tissue samples,151 composition of soybean meal,152 carbohydrate composition of recombinant modified tissue plasminogen activator,153 analysis of cyclization products from an enzyme reaction,154 carbohydrate content of glycoconjugate vaccines,155 and monitoring of patients with rheumatoid arthritis.156... 

Formulate a monitoring plan to evaluate the safety and efficacy of a therapeutic regimen designed for an individual patient with rheumatoid arthritis. 

TABLE 4-3 Clinical Monitoring of Drug Therapy in Rheumatoid Arthritis 1 ... 

Monitoring When indicated, monitor drug toxicity or efficacy through urinalysis. In rheumatoid arthritis patients, discontinue the drug if unexplained gross hematuria or persistent microscopic hematuria develops. Perform liver function tests and an annual x-ray for renal stones. 

Severe reactions Because of the possibility of severe toxic reactions (which can be fatal), fully inform patients of the risks involved and assure constant supervision. Deaths Use methotrexate only in life-threatening neoplastic diseases, or in patients with psoriasis or rheumatoid arthritis (RA) with severe, recalcitrant, disabling disease that is not adequately responsive to other forms of therapy. Deaths have occurred with the use of methotrexate in malignancy, psoriasis, and RA. Closely monitor patients for bone marrow, liver, lung, and kidney toxicities. 

CBC and platelets at 7, 10, and 14 days postdrug administration/injection due to the possibility of early-onset pancytopenia, a lower initial dose for rheumatoid arthritis treatment along with intensified monitoring during early therapy is recommended—CBCsat 1, 2, and 4 wk of treatment if stable, dose maybe increased and subsequent CBCs should be performed at monthly intervals... 

Other potential adverse responses include malignancy (e.g., lymphoma), liver disease, heart failure, lupuslike disease, irritation around the injection site, and demyelinating disorders that mimic multiple sclerosis.34,70 88 The incidence of these adverse effects, however, seems to be fairly low. For the most part, these drugs provide an acceptable risk-to-benefit ratio for most people with rheumatoid arthritis. Patients should, however, be screened carefully for any risk factors before beginning drug therapy, and should likewise be monitored periodically for any potential adverse reactions to these drugs. 

Kuhn E,Wu J, Karl J, et ah Quantification of C-reactive protein in the semm of patients with rheumatoid arthritis using multiple reaction monitoring mass spectrometry and 13C-labeled peptide standards. Proteomics (2004) 4 1-12. 

In the study of SLE patients, we and other authors have found that there is a correlation between SLE disease activity index (SLEDAI) and the production of IL-16 (L7) and IL-18 (W19). It was suggested that IL-16 and IL-18 may be a useful indicator of disease activity of SLE. Plasma MCP-1 concentration has also been proposed as a marker for monitoring joint inflammation in rheumatoid arthritis (El). 

Ms RR should be monitored for symptomatic relief, particularly joint mobility and pain. Laboratory monitoring should include erythrocyte-sedimentation rate (ESR) determination, a decrease in ESR approaching normal reference range (<20 mm/hour) indicates a positive response. Note ESR values are variable and fluctuate in various disease states. They are not diagnostic for rheumatoid arthritis per se, but levels often correlate with disease severity. 

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