Rheumatoid Juvenile

American Pain Society. Guideline for the Management of Pain in Osteoarthritis, Rheumatoid Arthritis, and Juvenile Chronic Arthritis. New York American Pain Society 2002 43-74. 

JRA Juvenile rheumatoid arthritis MS Mental status mitral stenosis musculoskeletal mul-... 

AOSD, adult onset Still disease AS, ankylosing spondylitis CA, crystal-induced arthritis ERA, enthesitis-related arthritis JA, juvenile arthritis PA, psoriatic arthritis RA, rheumatoid arthritis SE, synovium explants SLE, systemic lupus erythematosus SPCIA, solid phase 2 site chemiluminescent immunometric assay RP, relapsing polychondritis. 

Thompson SD, Luyrink LK, Graham TB, et al. Chemokine receptor CCR4 on CD4+ T cells in juvenile rheumatoid arthritis synovial fluid defines a subset of cells with increased IL-4 IFN-gamma mRNA ratios. J Immunol 2001 166(11) 6899-6906. 

A. Muhlberg, C. Linz, E. Bern, L. Tucker, M. Ver-have, and R. Grand, Identifaction of nonsteroidal anti-inflammatory drug induced gastrointestinal injury in children with juvenile rheumatoid arthritis, J. Pediatr, 122, 647 (1993). 

Heijnen, C.J. et al., Functional oij-adrenergic receptors on leukocytes of patients with polyarticular juvenile rheumatoid arthritis, J. Neuroimmunol., 71, 223, 1996. 

Culy CR, Keating GM. Etanercept. An updated review of its use in rheumatoid arthritis, psoriatic arthritis and juvenile rheumatoid arthritis. Drugs 2002 62 2493-537. 

Rheumatic disorders Adjunctive therapy for short-term use (acute episode or exacerbation) in psoriatic arthritis rheumatoid arthritis (RA), including juvenile RA ankylosing spondylitis acute and subacute bursitis acute, nonspecific tenosynovitis acute gouty arthritis posttraumatic osteoarthritis synovitis of osteoarthritis epicondylitis. 

Children The efficacy of penicillamine in juvenile rheumatoid arthritis has not been established. 

Chiidren Mefenamic acid and meclofenamate are not recommended in children younger than 14 years of age. Indomethacin is not recommended in children 14 years of age and younger, except in circumstances that warrant the risk. Safety and efficacy of meloxicam has not been established in children younger than 18 years of age. Tolmetin and naproxen are the only agents labeled for juvenile rheumatoid arthritis. Safety and efficacy of tolmetin in infants younger than 2 years of age are not established. Safety and efficacy of other NSAIDs in children are not established. 

Juvenile rheumatoid arthritis (JRA enteric-coated tablets) n the treatment of pediatric patients 6 years of age or older with polyarticular-course JRA who have responded inadequately to salicylates or other NSAIDs. 

Sulfasalazine also is indicated for use in rheumatoid arthritis and juvenile rheumatoid arthritis. Refer to the monograph in the Biologic and Immunologic Agents chapter. 

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. 

Polyarticular-course juvenile rheumatoid arthritis (JRA) Management of children with active polyarticular-course JRA who have had an insufficient therapeutic response to, or are intolerant of, an adequate trial of first-line therapy including full-dose NSAIDs. 

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). 

Children Safety and efficacy in patients with juvenile rheumatoid arthritis and in pediatric patients with Crohn disease have not been established. 

ITP idiopathic thrombocytopenic purpura IV intravenous IVP intravenous push JRA juvenile rheumatoid arthritis K/K potassium KVO ke vein open L/d liters per day LA long acting LDL low-density hpoprotein LFT liver function test LH leuteinizing hormone LHRH luteinizing hormone releasing hormone... 

Etanercept is a recombinant human soluble tumor necrosis factor-alpha (TNFo ) receptor fusion protein that binds to TNFo and decreases its role in disorders involving excess inflammation. It is approved for subcutaneous use in the treatment of patients with moderate to severe active rheumatoid arthritis, juvenile rheumatoid arthritis, psoriatic arthritis, ankylosing arthritis and plaque psoriasis. To the adverse reactions mentioned for infliximab, rare reports of congestive heart failure should be added. 

The autoimmune rheumatic diseases consists of Rheumatoid Arthritis (RA), Spondylarthritis (SpA), Systemic Lupus Erythematosus (SLE), Polymyositis, Dermatomyositis, Polymyalgia Rheumatica, Acute Temporal Arteritis, Giant Cell Arteritis, Behcet s Disease, Sjorgren s Syndrome, Felty s Syndrome and Mixed Connective Tissue Disease (MCTD). Spondylarthritis (SpA) can be subdivided in Reactive Arthritis (ReA), Ankylosing Spondylitis (AS), Psoriatic Arthritis (PsA), Arthritis associated with the inflammatory bowel diseases are Crohn s disease and Ulcerative Colitis (IBD), Undifferentiated SpA (UspA) and Sacro-ilitis, Juvenile SpA and Acute Anterior Uveitis (AAU). 

It is indicated in osteoarthritis, rheumatoid arthritis, musculoskeletal disorders, primary dysmenorrhoea, acute gout, pelvic inflammation, ankylosing spondylitis, tooth extraction, tendinitis, bursitis and juvenile arthritis. 

New indication Polyarticular-course juvenile rheumatoid arthritis... 

H. Other considerations Enbrel has been designated an orphan product for use in the treatment of juvenile rheumatoid arthritis and Wegener s granulomatosis. 

Indomethacin was particularly popular for gout and ankylosing spondylitis. In addition, it has been used to accelerate closure of patent ductus arteriosus. Indomethacin has been tried in numerous small or uncontrolled trials for many other conditions, including Sweet s syndrome, juvenile rheumatoid arthritis, pleurisy, nephrotic syndrome, diabetes insipidus, urticarial vasculitis, postepisiotomy pain, and prophylaxis of heterotopic ossification in arthroplasty. 

Cyclosporine is approved for use in rheumatoid arthritis and retards the appearance of new bony erosions. Its usual dosage is 3-5 mg/kg/d divided into two doses. Anecdotal reports suggest that it may be useful in systemic lupus erythematosus, polymyositis and dermatomyositis, Wegener s granulomatosis, and juvenile chronic arthritis. 

Sulfasalazine is effective in rheumatoid arthritis and reduces radiologic disease progression. It has been used in juvenile chronic arthritis and in ankylosing spondylitis and its associated uveitis. The usual regimen is 2-3 g/d. 

The compound is approved for the treatment of rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, juvenile idiopathic arthritis, plaque psoriasis, and Crohn s disease. It decreases the rate of formation of new erosions. It is effective both as monotherapy and in combination with methotrexate and other DMARDs. 

Etanercept is a dimeric fusion protein composed of human IgGj constant regions (CH2, CH3, and hinge, but not CH ) fused to the TNF receptor. Etanercept binds to both TNF- and TNF-3 and appears to have effects similar to that of infliximab, ie, inhibition of TNF-K-mediated inflammation, but its half-life is shorter due to its physical form (fusion protein) and the route of injection (subcutaneously, twice weekly). Etanercept is approved for adult rheumatoid arthritis, polyarticular-course juvenile rheumatoid arthritis, and psoriatic arthritis. It may be used in combination with methotrexate. 

Clinical use Tolmetin (Brogden et al., 1978b) is a nonsteroidal anti-inflammatory drug used for the treatment of mild to moderate pain states in musculoskeletal, soft tissue and joint disorders such as rheumatoid arthritis, osteoarthritis and gout as well as juvenile rheumatoid arthritis. 

Etanercept is a genetically engineered protein that is soluble TNF-a receptor. Its molecular weight is 75kDa. It binds to TNF-a. It is used for the treatment of rheumatoid arthritis, juvenile rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. Structurally, two TNF-a receptors are linked to an Fc portion of an... 

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