Salicylates
high dose aspirin
3-4 g/day
risk for bleeding, GI distress, ototoxic, hepatotoxic
Sometimes this is enough to help pts with their pain
celecoxib (Celebrex)
NSAID, cox-2 inhibitor
NSAIDs and salicylates
anti-inflammatory, analgesic, and antipyretic
may take 2-3 weeks for full effectiveness, not an instant
Corticosteroids
intraarticular injections
low dose oral for limited time
disease-modifying anti-rheumatic agents (DMARDs
decrease effects of RA
slow the disease progressions; decreases the risk of joint erosion and deformity, takes time to be effective, check labs, CBC, chemistries, and also with these meds, check for anemia, WBCs, and platelets
methotrexate
DMARD
common for RA
monitor for bone marrow suppression and hepatotoxicity
immunosuppressive agent
sulfasalazine (azulfidine)
DMARD
used for RA but also for other autoimmune diseases
Hydroxychloroquine (Plaquenil)
DMARD
antimalarial med good for use with RA
baseline and then yearly eye exam
SE: vision changes
leflunomide (Arava)
DMARD
teratogenic
hepatotoxic
blocks the immune cell overproduction
tofacitinib (Xeljanz)
DMARD
JAK (janus kinase) inhibitor
enzyme that leads to inflammation, so inhibits this
biologic response modifiers (BRMs)
also called biologics and immunotherapy
slows progression
classified based on MOA
used to treat moderate to severe disease not responsive to DMARDs
used alone or in combination with DMARDs
manipulates body immune system in less toxic manner
Tumor necrosis factor antagonists
BRM
binds with TNF inhibiting inflammation
TB test and CXR before start
monitor for infection
avoid live vaccines
infliximab (Remicade)
TNF A/BRM
IV infusion; monoclonal antibody; binds to TNF so patients are taught how to give this med to themselves bc it is a SQ shot
etanercept (Enbrel)
TNF A/BRM
SQ given 2x/week
adalimumab (Humira)
TNF A/BRM
monoclonal antibody, binds to TNF so that patients are taught how to give this med to themselves bc its a SQ shot
certolizumab (Cimzia) and golimumab (Simponi)
TNF A/BRM
TNF inhibitors that are given in combination with methotrexate
Biologic targeted therapy
interleukin antagonists
b cell antagonists
selective costimulation modulators
anakinra (Kineret)
interleukin antagonist
SQ
reduces pain and swelling
tocilizumab (Actemra)
interleukin antagonist
blocks IL-6, a proinflammatory cytokine
rituximab (Rituxan)
b cell antagonist
IV
targets b cells
abatacept (Orencia)
selective costimulation modulators
IV
blocks t cell activation