Drugs / Diseases

 

The Arthritis Society have information on types of arthritis, and  a helpful publication:  Arthritis Medications Guide

 

Here is a link to the 2017 Arthritis Alliance  Osteoarthritis Tool

We particualrly like this UK site which has great information on drugs and diseases

 

For rheumatoid arthritis you will be given our information package with disease and drug information . We prefer to offer verbal as well as written information to patients so you will get written information after your formal medication counselling session.

We follow the evidence for best practice very closely. In March 2014 the European League Against Rheumatism (EULAR) published an update to its recommendations on the use of disease modifying drugs and biologic medication in RA.

This open access review paper is available as a PDF:  Ann Rheum Dis-2014-Smolen-492-509

 

Dr Averns may discuss family planning with you.  This is because we need to consider the effects of your disease (and medication) on fertility, pregnancy and breast feeding, and also the effects of a pregnancy on your disease activity. This link will take you to a medscape article which, whilst intended for health care professionals, provides a good, but detailed summary of the current best practice in this area.

If you would prefer something a little more targeted at patients, try this American College of Rheumatology Patient information on pregnancy

 

 

Patients ask us about DRUG MONITORING with some of the disease modifying drugs we use – This is our current approach.

 

BEFORE STARTING DMARD THERAPY:

(MTX = METHOTREXATE, HCQ = HYDROXYCHLOROQUINE, SAS = SULFASALAZINE)

Investigations:

  • CBC and electrolytes including CRP and ESR
  • Chest x-ray
  • BP/ Weight / Height

Discuss with patient:

  • Co-Morbidities ie other illnesses which may be relevant to our choice
    Vaccinations
    Fertility/ Birth control

For MTX – ensure that Folic acid 5mg weekly has been prescribed

For HCQ – Ensure that eye monitoring is done within a year

MONITORING ON MTX:

  • 2 weekly CBC and ALT; AST; Creat and GFR for first  6 weeks
  • Monthly if first 6 weeks of monitoring stable

 

STOPPING TREATMENT:

In the following scenarios stop MTX, SSZ and AZA until resolved:

  • If Neutrophils < 1.6
  • If ALT / AST >100
  • If GFR <60ml/min with a 30% decrease in Creat
  • If there is a serious infection
  • THERE IS USUALLY  NO INDICATION TO STOP MTX FOR SURGERY

Ref: BSR guidelines. Ledingham et al: Rheumatology 2017;56:865-868 doi:10.1093/rheumatology/kew479