Antimalarials
Like many other drugs used for rheumatoid arthritis, this class of drugs was first used for another illness, in this case malaria. No one knows why antimalarials are effective in treating rheumatoid arthritis. The most commonly used antimalarial is hydroxychloroquine sulfate (Plaquenil). About 70% of rheumatoid arthritis patients respond to this drug, at least to some extent. Hydroxychloroquine’s most feared risk is vision loss due to retinal injury. Serious retinal damage occurs in less than 1% of those who use it, but blindness is a frightening possibility, and it sometimes occurs months after the drug is discontinued.
Gold Salts
Gold salts, whether taken by injection or orally, are one of the most effective but toxic treatments for rheumatoid arthritis. Various gold compounds, administered orally or by injection, can suppress synovial inflammation, bring about partial or full remission, and perhaps slow joint damage. However, disturbing side effects develop in about one-third of patients who take gold, including changes in taste sensation, intense skin rashes that can be dangerous, and severe inflammation of mucous membranes. Less common but even more serious toxic effects include bone marrow injury, liver toxicity, and kidney damage.
D-Penicillamine
D-penicillamine is another dual-use drug also employed to treat certain forms of metal poisoning. It is about as effective as gold injections; but because it causes a high rate of serious reactions (up to 50%), it is usually only tried when gold fails. Common problems include fever, rash, itching, nausea and stomach pain, loss of appetite, mouth ulcers, and altered taste sensation. Serious injury to the bone marrow or kidneys is not infrequent.
Sulfasalazine
Sulfasalazine (Azulfidine EN-tabs), long used for inflammatory bowel disease, was recently approved by the Food and Drug Administration for rheumatoid arthritis as well. Although usually less effective than gold or penicillamine, it is also less toxic. Nonetheless, it can cause nausea, vomiting, abdominal pain, dizziness, and oversensitivity to the sun. Most seriously, sulfasalazine can sometimes cause a dangerous drop in a type of white blood cell known as neutrophils. To ward against this reaction, white count must be checked frequently during treatment.
*25/306/5*
Random Posts