By Hilary Capell;Rajan Madhok;Iain B McInnes
Healing recommendations within the remedy of rheumatoid arthritis are increasing speedily, with the arrival of novel recommendations of remedy, including the arriving of latest healing brokers, together with "biologics." For future health care execs who deal with rheumatoid arthritis, this functional handbook winnows all that info down right into a useful reference. particularly, this booklet presents prepared entry to the knowledge crucial for secure and powerful prescribing. The authors use their collective services in medical care and study to supply a transparent and entire consultant to treating rheumatoid arthritis.
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Additional resources for Practical Prescribing Guidelines for Rheumatoid Arthritis
1991 MTX vs AZA RA Doubleblind RCT 1 year MTX superior to AZA Weinblatt et al. 1993 MTX vs auranofin RA Doubleblind RCT Rau et al. 1991 MIX vs IM gold RA Doubleblind RCT Strand et al. 1999 MTX vs LEF vs placebo RA Doubleblind RCT 1 year Equal efficacy Bathon et al. 2000 MTX vs etanercept Early RA Doubleblind RCT 1 year Equal efficacy Little radiographic progression on MTX Outcome toxicity Comment reducing efficacy Toxicity Use of folic reduced with acid reduces folic acid MTX toxicity without reducing efficacy Use of folic Primarily acid (daily) hepatic or folinic toxicity acid reduced by (weekly) folic acid or reduces folinic acid MTX toxicity MTX better MTX is tolerated more than AZA effective than azathioprine, and better tolerated 9 months MIX superior to Aur for radiographic outcome 6 months Equal efficacy Fewer adverse events with etanercept Methotrexate is more effective than auranofin MIX and IM gold have equal efficacy, but MIX is better tolerated MTX and LEF have equivalent efficacy and toxicity In early RA, MTX is as effective as etanercept 3 DMARDS 49 Figure 1 Treatment of active rheumatoid arthritis with leflunomide compared with placebo and methotrexate.
The commonest adverse events are shown in Table 4. Nausea and oral ulceration may be significant but usually respond to local or symptomatic therapy. Serious and life-threatening toxicity is uncommon, but several deaths have been reported in prospective clinical trials or in case reports. Opportunistic infection occurs rarely, but can be fatal. The following areas merit particular emphasis. Hepatic toxicity Transaminase elevation is variable in practice but occurs in approximately 10% of MTXtreated patients in clinical trials.
1990) in meta-analyses. It is more effective than auranofin (see p. 80). Long’ term retention of gold is not as good as methotrexate, because of increased patient withdrawal because of side-effects. EVIDENCE OF BENEFIT IN RA Table 1 shows the evidence for clinical benefit against placebo Table 2 shows clinical comparison with other DMARDs Table 3 shows evidence from radiological studies Table 4 shows long-term studies Injectable gold has been studied over many years: indeed Fraser conducted a study in 1945 in Glasgow that demonstrated clinical benefit.