A relatively newer biologic, rituximab provides an alternative strategy for treating the presenting patient. A genetically engineered chimeric anti-CD20 monoclonal antibody, rituximab exerts it therapeutic action by selectively targeting CD-20 positive B-cells1212, 18. As CD-20 is expressed exclusively on pre-B and mature B lymphocytes; stem cells and plasma cells are not implicated in rituximab therapy. The over expression of B-cells expressing the CD-20 surface antigen in the synovium of RA-affected joints has been well established18. The potential mechanisms by which these B-cells contribute to the immunopathogenesis of RA are as follows: they can act as antigen presenting cells, secrete pro-inflammatory cytokines (including tumour necrosis factor-alpha), and generate rheumatoid factor (RF) and other auto-antibodies whilst also activating T cells12. Hence, the rituximab mediated depletion of B-cells is thought to prevent these potential mechanisms from occurring thus controlling the progression of the disease18. Rituximab therapy consists of two 1000mg infusions, given two weeks apart at intervals of no less than 2 weeks. The projected cost of a single course of rituximab therapy is around £349211 and if clinically efficient would offer the patient a more convenient dosing schedule compared to Anti-TNF therapy. The annual cost does however depend on how often the patient is required to undergo a course of rituximab therapy11. An RCT aimed at investigating different rituximab dosing regimens in methotrexate resistant patients referred to as the DANCER trial, provides significant evidence conveying the potential benefit of rituximab therapy19. As part of the trial, patients received rituximab 500MG, rituximab 1000mg or placeb... ... middle of paper ... ...50 (7): 754--766. 27. Kaneko A. Tocilizumab in rheumatoid arthritis: efficacy, safety and its place in therapy.Therapeutic advances in chronic disease. 2013; 4 (1): 15--21. 28. An M, Zou Z, Shen H, Zhang J, Cao Y, Jiang Y. The addition of tocilizumab to DMARD therapy for rheumatoid arthritis: a meta-analysis of randomized controlled trials. European journal of clinical pharmacology. 2010; 66 (1): 49--59. 29. Schmitt C, Kuhn B, Zhang X, Kivitz A, Grange S. Disease--drug--drug interaction involving tocilizumab and simvastatin in patients with rheumatoid arthritis. Clinical Pharmacology & Therapeutics. 2011; 89 (5): 735--740. 30. Ding T, Ledingham J, Luqmani R, Westlake S, Hyrich K, Lunt M, Kiely P, Bukhari M, Abernethy R, Bosworth A, Others. BSR and BHPR rheumatoid arthritis guidelines on safety of anti-TNF therapies.Rheumatology. 2010; 49 (11): 2217--2219.
Turner MK, Hooten WM, Schmidt JE, Kerkvliet JL, Townsend CO, Bruce BK. Prevalence and Clinical Correlates of Vitamin D Inadequacy among Patients with Chronic Pain. Pain Medicine. 2008;9(8):979-984.
that cause dark red blotches on the skin, usually on the face). Laboratory tests are another consideration of diagnosis. Tests consist of anti-nuclear anti-body (ANA) counts and anti-topoisomerase (an enzyme that reduces super-coiling in DNA by breaking and rejoining one or both strands of DNA). High ANA’s and low anti-topoisomerases are found in patients with Raynaud syndrome. (Desai, 2003) “Patients with circulating autoantibodies, antinuclear antibodies, and anti-Scl 70 antibodies are at (an) increased risk of developing a connective tissue disease. Systemic sclerosis is the connective tissue disease most frequently associated with Raynaud’s phenomenon.” (Bowling, 2003) This syndrome is described as primary Raynaud phenomenon (PRP) if is not associated with another disorder and as secondary Raynaud phenomenon (SRP) if it occurs in association with another disorder.
Rheumatoid arthritis is a chronic inflammatory and an autoimmune disease that occurs when the immune system mistakenly attacks the body’s tissue (Rheumatoid arthritis, 2017). This disease affects the entire body, which is called a systemic (means entire body) disease. Arthritis is derived from the word part arthr-, which means “joint,” and -itis, which means “inflammation,” so altogether it means “inflammation of the joints.” It creates inflammation that causes the tissue that lines the inside of joints (synovium) to thicken. About 1.5 million people in the U.S. are affected. It affects all races, but it affects three times as many women than men (What is Rheumatoid Arthritis, n.d.). Overtime, rheumatoid arthritis causes painful swelling that can potentially result in bone erosion or joint deformity, which leads up to physical disabilities. RA can affect more than just your joints, but can spread to body systems, skin, eyes, lungs, heart, blood vessels, e.t.c (Rheumatoid arthritis, 2017).
...ients suffering chiefly from insomnia, but I would consider prescribing it to patients with rheumatoid arthritis or similar illnesses as a mild sleep aid.
Makover, M. & Zieve, D. (2011, February 14). Systemic Lupus Erythematosus. National Center for Biotechnology Information. Retrieved July 14, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001471/
Osteoarthritis is not a curable condition, but it can be treated using both pharmacological and nonpharmacological methods. Mild analgesics are a common form of treatment for OA, including Acetaminophen and NSAIDs, taking into consideration other co-morbidities that may be present. It is recommended that adults over 75 years of age utilize topical NSAIDs rather than oral for treatment of the pain (Tugwell et al, 2012). Research by A...
Arthritis affects people of all age groups. More than 100 types of arthritis are known. Among these osteoarthritis and rheumatoid arthritis having the highest incidence. One of the major causes of chronic debilitation in industrialized nations is Osteoarthritis which results from damage to the joints, which may be due to trauma, infection, or age-related wear. Rheumatoid arthritis is encountered less frequently than osteoarthritis and is estimated to affect around one per cent of the world’s population. Amongst patients of Rheumatoid arthritis, women are three times more likely to be affected by this condition than men. This condition is caused by an inflammatory process where the body starts attacking itself. Rheumatoid arthritis also affects several joints, with inflammation sometimes seen in and around the lungs, the heart, the eyes and the skin. The most commonly reported complaint by arthritis patients is pain. The pain might be from the joint itself and be a result of inflammation, damage from the disease, or through daily wear and tear. Muscle pain is also common and is caused by having to force movements against stiff and painful joints. Although range of movement in the affected joint may be limited and uncomfortable, physical exercise has been shown to benefit those with arthritis. Physical therapy has been shown to significantly improve function, decrease pain in the long term and delay the need for surgery in advanced cases. The majority of arthritis cases occur among theelderly, however the disease can occur in children as well. Over 70% of the population that get affected by arthritis in North America are over the age of 65 (4). The disease occurs more commonly in females than males in all races, age groups, and ethn...
Rosendo is a 32-year-old male who suffers from chronic plaque psoriasis (L40.0), along with psoriatic arthritis. His symptoms include dry, itchy, scaly, large, thick patches of plaques, located on his arms, back, legs, scalp, and behind his ears, as well as experiencing tenderness in the knees and fingers. Rosendo has tried and failed various treatments including triamcinolone, which provided little to no relief. Cosentyx was denied stating that the records sent do not show that he has tried another medication like Methotrexate, Cyclosporine or Acitretin. He is not a candidate for Methotrexate, Acitretin, and Cyclosporine as they have Black Box warnings due to the dangerousness of the side effects causes by these specific treatments, in addition
It is used for the treatment of arthritis and also for treating the back pain, shoulder pain and knee pain.
There are many options for substance addiction treatment and utilizing medication as a means of eliminating substance use is one that has been called a double edge sword. There are two schools of thought with medically assisted treatment. First, let 's define medication assisted treatment (MAT): “it is the use of pharmacological medications, in combination with counseling and behavioral therapies, to provide a “whole patient” approach to the treatment of substance use disorders. Research indicates that a combination of medication and behavioral therapies can successfully treat substance use disorders, and for some people struggling with addiction, MAT can help sustain recovery” (Watkins, 2016). One side of this treatment option is that it provides that extra little nudge to start recovery with less or more withdrawal symptoms. For example, disulfiram is an alcohol aversion agent, that when taken with alcohol the person becomes very ill (Watkins, 2016). There are also other medications that help with reducing symptoms of withdrawal, such as methadone.
It is still unknown what the cause of Rheumatoid Arthritis is but there are some theories that have not been proven. The oldest theory states that viruses and bacteria are the cause of Rheumatoid Arthritis. Now with all the research being done, scientists believe that Rheumatoid Arthritis is hereditary. Specific genes have been found to make people more likely to get Rheumatoid Arthritis. Some scientists also think that some environmental factors and infections might cause the immune system to attack. Contributing factors are smoking and being exposed to silica metal. So although the exact causes are unknown, the result is that the immune system is ready to make the joins and tissues inflamed by activating immune cells.
Bibliography: Arthritis Foundation, Understanding Arthritis (1986); Kelley, William N., et al., eds., Textbook of Rheumatology, 2d ed., (1985); McCarty, Daniel F., ed., Arthritis and Allied Conditions, 11th ed. (1988); Moll, J. M. H., Rheumatology in Clinical Practice (1987).
Polypharmacy is the “concurrent use of several differ drugs and becomes an issue in older adults when the high number of drugs in a medication regimen includes overlapping drugs for the same therapeutic effect”(Woo & Wynne, 2011, p. 1426). The patient is currently taking several medications that can potential interact with each other, perform the same therapeutic effect, and creating side effects. The following is a list of her medications and their indications:
Turner, B. J., Newschaffer, C. J., Zhang, D., Fanning, T., & Hauck, W. W. (1999). Translating clinical trial results into practice. Annals of Internal Medicine, 130(12), 979-986.
...g on their own. The steroids are tapered off and the immune system suppressant drugs take over. Side effects can include allergic reactions, bone marrow suppression, infections, and inflammation of the liver and pancreas. Cyclosporine, infliximab, and adalimumab are used in people with severe UC that don’t respond to other drugs. Side effects are severe and include kidney damage, seizures and fatal infection. Some people are at risk for development of cancer with these types of medications.