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DMARDS- Disease-modifying anti-rheumatic drugs (DMARDs) are a class of…
DMARDS- Disease-modifying anti-rheumatic drugs (DMARDs) are a class of drugs, which are not used to simply treat symptoms but influence the course of a disease. Due to increased risk of complications and infections they require regular monitoring.
Classes
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biologic
Some are called anti TNF drugs as they target tumour necrosis factor. TNF increases inflammation when excess amounts are found in blood or bone
Newer class, which work quicker than conventional DMARDs.
.Used when conventional DMARDs have not been effective., or have developed side effects to them
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Referral to rheumatology immediately and treatment stopped on any DMARDs if presents with any symptoms
Skin/mucosal reaction — for example rash, pruritus, mouth or throat ulceration.
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Nausea, vomiting, diarrhoea or weight loss.
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Breathlessness, infection or cough.
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Monitoring
U&Es - Creatinine has increased more than 30% over 12 months and/or calculated GFR is less than 60 mL/min.
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FBC- White cell count less than 3.5 x 109/L, Mean cell volume more than 105 fL, Neutrophils less than 1.6 x 109/L, Unexplained eosinophilia more than 0.5 x 109/L, Platelet count less than 140 x 109/L
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Referral to rheumatology immediately and treatment stopped on Biologic DMARDs if presents with any symptoms
Cough, haemoptysis, or weight loss (symptoms of tuberculosis)
Signs or symptoms of heart failure, or worsening heart failure.
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Severe abdominal pain, or unexplained change in bowel habits accompanied by fever
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