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Diseases » Rheumatoid arthritis » Treatments
 

Treatments for Rheumatoid arthritis

Contents
  1. Rheumatoid arthritis: Introduction
  2. Treatments for Rheumatoid arthritis (Introduction)
  3. Treatment list for Rheumatoid arthritis
  4. Alternative Treatments
  5. News about treatments
  6. Discussion of treatments for Rheumatoid arthritis
  7. Buy Products Related to Treatments for Rheumatoid arthritis
  8. Rheumatoid arthritis: Introduction

Treatments for Rheumatoid arthritis:

There is no known preventive treatment for rheumatoid arthritis, but with early recognition and treatment, it is possible to minimize joint damage and complications of the disease. Because of the ongoing, or chronic nature of the disease, treatment also usually needs to be ongoing, even lifelong in some cases. The most successful treatment plans usually use a multipronged approach. After a complete evaluation, your health care professional will work with you to develop treatment goals and a treatment plan that will be most effective for your specific condition and lifestyle. Common treatments include physical therapy and appropriate periods of rest, medications, and in some cases surgery.

Physical therapy is an important part of a complete treatment plan for rheumatoid arthritis. Physical therapy, including range-of-motion exercises, can help to strengthen joints and delay the loss of joint function. Orthopedic splints, heat and cold therapies and electrical stimulation treatments may also be helpful. Physical therapy programs are individualized by a physical therapist in conjunction with health care team of providers based on your specific case. It is also important to get a good night's sleep and to have appropriate periods of rest.

Medications commonly used to treat rheumatoid arthritis include disease modifying anti-rheumatic drugs (DMARDs). Most often methotrexate (Rheumatrex) is prescribed. Less often the drug leflunomide (Arava) is used. These medications appear to reduce inflammation and slow down the destruction of joints due to rheumatic arthritis. DMADs do not relieve pain or symptoms quickly but are considered effective for long-term control of symptoms. It may take six to eight months of treatment with DMARDs to see results.

Anti-inflammatory medications are also commonly used to control symptoms. These include non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) and aspirin. NSAIDs are very effective in treating the pain and inflammation of rheumatoid arthritis. However, long-term use of NSAIDs can cause serious, even life threatening, side effects and adverse events. These include bleeding gastrointestinal ulcers and possible heart problems and cardiovascular events. Because aspirin and many NSIADS are available over-the counter, it is important that you do not start a medication regime before consulting a health care professional who will evaluate your individual case and needs.

Other medications used for the treatment of rheumatoid arthritis include the cyclooxygenase-2 (COX-2) inhibitors, which block an inflammation-promoting enzyme called COX-2. However, this class of drugs has been linked with heart attack and stroke and their safety is currently being re-evaluated. The COX-2 inhibitors, celecoxib (Celebrex) is still available by prescription, but its label contains strong warning about possible serious adverse events. When it is prescribed, it is recommended to use the lowest possible dose for the shortest period possible. Only a qualified health care professional can evaluate if the benefits of using celecoxib are outweigh the risks in your particular case. It is very important not to take someone else's prescription for a COX-2 inhibitor or any other medication. Corticosteroids can be used to reduce inflammation in rheumatoid arthritis but have a potential for serious long-term side effects, so these drugs are generally only used for short periods and in low doses. Other medications that are used to treat rheumatoid arthritis by decreasing inflammation include tumor necrosis factor (TNF) inhibitors, and the human interleukin-1 receptor antagonist Anakinra (Kineret). Anakinra is usually only used to treat rheumatoid arthritis that has not responded to other medication or treatments. There are a variety of other medications available to treat severe rheumatoid arthritis or cases that are not responding to other therapies. These include immunosuppressant drugs, which are associated with toxic side effects.

Surgery may be used to help improve joint pain, correct deformities, and help increase function in seriously affected joints. The most effective surgeries include those performed on the knees and hips. Surgery may include a synovectomy, the removal of the joint lining. Total joint replacements may also be performed in severe cases. In these cases, a diseased joint in the knee or hip is replaced with a new, synthetic joint (prosthesis).

In some cases, depression may accompany the chronic or untreated pain in rheumatoid arthritis. Untreated or undertreated pain can lead to depression in some people. Current research also suggests that the two conditions may be connected because the mood and pain perception centers in the brain are both located in the same areas. In these cases antidepressants, such as amitriptyline (Elavil), venlafaxine (Effexor), and duloxetine (Cymbalta), may be prescribed and may help reduce the need for pain medications. Only a thorough evaluation by a qualified health care professional can determine if antidepressant medication is appropriate in your case.

All medications have potentially serious side effects and adverse reactions, so it is vital to take medications exactly as directed and to immediately report any side effects to your to tell your health care provider.

Treatments for Rheumatoid arthritis

The list of treatments mentioned in various sources for Rheumatoid arthritis includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.

Rheumatoid arthritis: Is the Diagnosis Correct?

The first step in getting correct treatment is to get a correct diagnosis. Differential diagnosis list for Rheumatoid arthritis may include:

Rheumatoid arthritis: Marketplace Products, Discounts & Offers

Products, offers and promotion categories available for Rheumatoid arthritis:

Curable Types of Rheumatoid arthritis

Possibly curable types of Rheumatoid arthritis may include:

Rheumatoid arthritis: Research Doctors & Specialists

Research all specialists including ratings, affiliations, and sanctions.

Drugs and Medications used to treat Rheumatoid arthritis:

Note:You must always seek professional medical advice about any prescription drug, OTC drug, medication, treatment or change in treatment plans.

Some of the different medications used in the treatment of Rheumatoid arthritis include:

  • Anakinra
  • Kineret
  • Auranofin
  • Ridaura
  • Azathioprine
  • Imuran
  • Med-Azathioprine
  • Riva-Azathioprine
  • Celecoxib
  • Celebrex
  • Rofecoxib
  • Vioxx
  • Valdecoxib
  • Bextra
  • Cyclosporine
  • Neoral
  • Enbrel
  • TNFR:Fc
  • Fenamate
  • Meclofenamate
  • Meclodium
  • Meclofenaf
  • Meclomen
  • Mefenamic Acid
  • Apo-Mefanamic
  • Novo-Mefanamic
  • Ponstel
  • Ponstan
  • Hydroxychloroquine
  • Plaquenil
  • Infliximab - used as part of a combination treatment
  • Anti TNF monoclonal antibody - used as part of a combination treatment
  • Remicade - used as part of a combination treatment
  • Leflunomide
  • Arava
  • Methotrexate
  • Abitrexate
  • Folex
  • Folex PFS
  • Mexate
  • Mexate AQ
  • Rheumatrex Dose Pack
  • Trexall
  • Oxicams
  • Alti-Piroxicam
  • Apo-Piroxicam
  • Brexidol
  • Dom-Piroxicam
  • Feldene
  • Med-Pirocam
  • Novo-Pirocam
  • Nu-Pirox
  • Penicillamine
  • Cuprimine
  • Depen
  • Propionic Acid
  • Fenoprofen
  • Nalfon
  • Flurbiprofen
  • Ansaid
  • Apo-Flurbiprofen
  • Froben
  • Froben-SR
  • Novo-Flurbiprofen
  • Ocufen
  • Ibuprofen
  • Aches-N-Pain
  • Actiprofen
  • Advil
  • Advil Migraine
  • Amersol
  • Apo-Ibuprofen
  • Arthritis Foundation Pain Reliever/Fever Reducer
  • Bayer Select
  • Children's Advil
  • Children's Motrin
  • Children's Motrin Drops
  • Children's Motrin Suspension
  • CoAdvil
  • Excedrin IB
  • Genpril
  • Guildprofen
  • Haltran
  • Ibu
  • Ibuprohm
  • Junior Strength Motrin Caplets
  • Medipren
  • Medi-Profen
  • Profen-IB
  • Rufen
  • Superior Pain Medicine
  • Supreme Pain Medicine
  • Tab-Profen
  • Ketoprofen
  • Actron
  • Apo-Keto
  • Apo-Keto E
  • Orudis
  • Orudis E-50
  • Orudis E-100
  • Orudis KT
  • Orudis SR
  • Oruvail
  • Oruvail ER
  • Oruvail SR
  • Rhodis
  • Rhodis EC
  • Rhodis EC Suppository
  • Naproxen
  • Aleve
  • Anaprox
  • Anaprox DS
  • Apo-Naproxen
  • Naprelan
  • Naprelan Once Daily
  • Naprosyn
  • Naxen
  • Neo-Prox
  • Novo-Naprox
  • Nu-Naprox
  • Synflex
  • Oxaprozin
  • Daypro
  • Sulfasalazine
  • Alti-Sulfasalazine
  • Azaline
  • Azulfidine
  • Azulfidine EN-Tabs
  • PMS Sulfasalazine
  • PMS Sulfasalazine E.C
  • Salazopyrin
  • Salazopyrin EN
  • SAS-Enema
  • SAS Enteric-500
  • SAS-500
  • Sulfazine EC
  • Etanercept
  • Adalimumab
  • Humira
  • Aspercin
  • Aspercin Extra
  • Bayer Aspirin Regimen Adult Low Strength
  • Bayer Aspirin Regimen Children's
  • Bayer Aspirin Regimen Regular Strength
  • Bayer Extra Strength Arthritis Pain Regimen
  • Bayer Women's Aspirin Plus Calcium
  • Buffinol
  • Buffinol Extra
  • Ecotrin Low Strength
  • Ecotrin Maximum Strength
  • Sureprin 81
  • Asaphen
  • Asaphen E.C
  • ASA 500
  • Coraspir
  • Capsaicin
  • ArthriCare for Women Extra Moisturizine
  • ArthriCare for Women Multi-Action
  • ArthriCare for Women Silky Dry
  • ArthriCare for Women Ultra Strength
  • Capsagel
  • Capzasin-HP
  • Capzasin-P
  • Zostrix
  • Zostrix-HP
  • Antiphogistine Rub A-535 Capsaicin
  • Choline Magnesium Trisalicylate
  • Trilisate
  • Choline Salicylate
  • Teejel
  • Gengraf
  • Apo-Cyclosporine
  • Rhoxal-Cyclosporine
  • Diflunisal
  • Dolobid
  • Apo-Diflunisal
  • Novo-Diflunisal
  • Nu-Diflunisal
  • Gold Sodium Thiomalate
  • Myochrysine
  • Apo-Leflunomide
  • Rheumatrex
  • Trexal
  • Apo-Methotrexate
  • Ratio-Methotrexate
  • Ledertrexate
  • Texate
  • Trixilem
  • Tiaprofenic Acid
  • Albert Tiafen
  • Apo-Tiaprofenic
  • Dom-Tiaprofenic
  • Novo-Tiaprofenic
  • Nu-Tiaprofenic
  • PMS-Tiaprofenic
  • Surgam
  • Surgam SR
  • Tiaprofenic-200
  • Tiaprofenic-300
  • Cortate
  • Cortisone Acetate

Unlabeled Drugs and Medications to treat Rheumatoid arthritis:

Unlabelled alternative drug treatments for Rheumatoid arthritis include:

  • Captopril
  • Apo-Capto
  • Capoten
  • Capozide
  • Novo-Captopril
  • Nu-Capto
  • Syn-Captopril
  • Enalapril
  • Lexxel
  • Vaseretic
  • Vasotec
  • Chlorambucil
  • Leukeran
  • Alti-Chlorambucil
  • Cyclophosphamide
  • Cycloblastin
  • Cytoxan
  • Neosar
  • Procytox
  • Sulfonamide antibiotic
  • Sulfamethoxazole
  • Apo-Sulfamethoxazole
  • Apo-Sulfatrim
  • Apo-Sulfatrim DS
  • Azo Gantanol
  • Bactrim
  • Bactrim DS
  • Bethaprim
  • Comoxol
  • Cotrim
  • Gantanol
  • Novo-Trimel
  • Novo-Trimel DS
  • Nu-Cotrimox
  • Protrin
  • Protrin DF
  • Roubac
  • Septra
  • Septra DS
  • Sulfatrim
  • Uro Gantanol
  • Uroplus DS
  • Uroplus SS
  • Vagitrol
  • Alti-Captopril
  • Gen-Captopril
  • PMS-Captopril
  • Captral
  • Cardipril
  • Cryopril
  • Ecaten
  • Kenolan
  • Lenpryl
  • Romir
  • Chloroquine
  • Aralen
  • Feliberal
  • Glioten
  • Kenopril
  • Norpril
  • Palane
  • Pulsol
  • Renitec
  • Immune Globulin (intravenous)
  • Carimune
  • Carimune NF
  • Flebogamma
  • Gamimune N
  • Gammagard S/D
  • Gammar-P
  • Gamunex
  • Iveegam EN
  • Octagam
  • Panglobulin
  • Panglobulin NF
  • Polygam S/D
  • Iveegam Immuno
  • Cilax
  • Intacglobin
  • Sandoblobulina
  • Thalidomide
  • Thalomid

Hospital statistics for Rheumatoid arthritis:

These medical statistics relate to hospitals, hospitalization and Rheumatoid arthritis:

  • 0.05% (6,633) of hospital consultant episodes were for seropositive rheumatoid arthritis in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
  • 95% of hospital consultant episodes for seropositive rheumatoid arthritis required hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
  • 27% of hospital consultant episodes for seropositive rheumatoid arthritis were for men in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
  • 73% of hospital consultant episodes for seropositive rheumatoid arthritis were for women in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
  • 9% of hospital consultant episodes for seropositive rheumatoid arthritis required emergency hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
  • more hospital information...»

Medical news summaries about treatments for Rheumatoid arthritis:

The following medical news items are relevant to treatment of Rheumatoid arthritis:

Discussion of treatments for Rheumatoid arthritis:

Questions and Answers About Knee Problems: NIAMS (Excerpt)

Rheumatoid arthritis of the knee may require physical therapy and more powerful medications. In people with arthritis of the knee, a seriously damaged joint may need to be replaced with an artificial one. (A new procedure designed to stimulate the growth of cartilage by using a patient's own cartilage cells is being used experimentally to repair cartilage injuries at the end of the femur at the knee. It is not, however, a treatment for arthritis.) (Source: excerpt from Questions and Answers About Knee Problems: NIAMS)

Handout on Health Rheumatoid Arthritis: NIAMS (Excerpt)

Doctors use a variety of approaches to treat rheumatoid arthritis. These are used in different combinations and at different times during the course of the disease and are chosen according to the patient's individual situation. No matter what treatment the doctor and patient choose, however, the goals are the same: relieve pain, reduce inflammation, slow down or stop joint damage, and improve the person's sense of well-being and ability to function.

Treatment is another key area for communication between patient and doctor. Talking to the doctor can help ensure that exercise and pain management programs are provided as needed and that drugs are prescribed appropriately. Talking can also help in making decisions about surgery.

Goals of Treatment

  • Relieve pain
  • Reduce inflammation
  • Slow down or stop joint damage
  • Improve a person's sense of well-being and ability to function

Current Treatment Approaches

  • Lifestyle
  • Medications
  • Surgery
  • Routine monitoring and ongoing care

Lifestyle

This approach includes several activities that help improve a person's ability to function independently and maintain a positive outlook.

Rest and exercise: Both rest and exercise help in important ways. People with rheumatoid arthritis need a good balance between the two, with more rest when the disease is active and more exercise when it is not. Rest helps to reduce active joint inflammation and pain and to fight fatigue. The length of time needed for rest will vary from person to person, but in general, shorter rest breaks every now and then are more helpful than long times spent in bed.

Exercise is important for maintaining healthy and strong muscles, preserving joint mobility, and maintaining flexibility. Exercise can also help people sleep well, reduce pain, maintain a positive attitude, and lose weight. Exercise programs should be planned and carried out to take into account the person's physical abilities, limitations, and changing needs.

Care of joints: Some people find that using a splint for a short time around a painful joint reduces pain and swelling by supporting the joint and letting it rest. Splints are used mostly on wrists and hands, but also on ankles and feet. A doctor or a physical or occupational therapist can help a patient get a splint and ensure that it fits properly. Other ways to reduce stress on joints include self-help devices (for example, zipper pullers, long-handled shoe horns); devices to help with getting on and off chairs, toilet seats, and beds; and changes in the ways that a person carries out daily activities.

Stress reduction: People with rheumatoid arthritis face emotional challenges as well as physical ones. The emotions they feel because of the disease--fear, anger, frustration--combined with any pain and physical limitations can increase their stress level. Although there is no evidence that stress plays a role in causing rheumatoid arthritis, it can make living with the disease difficult at times. Stress may also affect the amount of pain a person feels. There are a number of successful techniques for coping with stress. Regular rest periods can help, as can relaxation, distraction, or visualization exercises. Exercise programs, participation in support groups, and good communication with the health care team are other ways to reduce stress.

Healthful diet: With the exception of several specific types of oils (mentioned in the Current Research section), there is no scientific evidence that any specific food or nutrient helps or harms most people with rheumatoid arthritis. However, an overall nutritious diet with enough--but not an excess of--calories, protein, and calcium is important. Some people may need to be careful about drinking alcoholic beverages because of the medications they take for rheumatoid arthritis. Those taking methotrexate may need to avoid alcohol altogether. Patients should ask their doctors for guidance on this issue.

Climate: Some people notice that their arthritis gets worse when there is a sudden change in the weather. However, there is no evidence that a specific climate can prevent or reduce the effects of rheumatoid arthritis. Moving to a new place with a different climate usually does not make a long-term difference in a person's rheumatoid arthritis.

Medications

Most people who have rheumatoid arthritis take medications. Some medications are used only for pain relief; others are used to reduce inflammation. Still others--often called disease-modifying antirheumatic drugs, or DMARDs--are used to try to slow the course of the disease. The person's general condition, the current and predicted severity of the illness, the length of time he or she will take the drug, and the drug's effectiveness and potential side effects are important considerations in prescribing drugs for rheumatoid arthritis. The table below about "Medications Commonly Used To Treat Rheumatoid Arthritis" shows currently used rheumatoid arthritis medications, along with their effects, side effects, and monitoring requirements.

Traditionally, rheumatoid arthritis therapy has involved an approach in which doctors prescribed aspirin or similar drugs, rest, and physical therapy first, and prescribed more powerful drugs later only if the disease became much worse. Recently, many doctors have changed their approach, especially for patients with severe, rapidly progressing rheumatoid arthritis. This change is based on the belief that early treatment with more powerful drugs, and the use of drug combinations in place of single drugs, may be more effective ways to halt the progression of the disease and reduce or prevent joint damage. (Source: excerpt from Handout on Health Rheumatoid Arthritis: NIAMS)

Handout on Health Rheumatoid Arthritis: NIAMS (Excerpt)

Several types of surgery are available to patients with severe joint damage. The primary purpose of these procedures is to reduce pain, improve the affected joint's function, and improve the patient's ability to perform daily activities. Surgery is not for everyone, however, and the decision should be made only after careful consideration by patient and doctor. Together they should discuss the patient's overall health, the condition of the joint or tendon that will be operated on, and the reason for and the risks and benefits of, the surgical procedure. Cost may be another factor. Commonly performed surgical procedures include joint replacement, tendon reconstruction, and synovectomy.

Joint replacement: This is the most frequently performed surgery for rheumatoid arthritis, and it is done primarily to relieve pain and improve or preserve joint function. Artificial joints are not always permanent and may eventually have to be replaced. This may be an issue for younger people.

Tendon reconstruction: Rheumatoid arthritis can damage and even rupture tendons, the tissues that attach muscle to bone. This surgery, which is used most frequently on the hands, reconstructs the damaged tendon by attaching an intact tendon to it. This procedure can help to restore hand function, especially if the tendon is completely ruptured.

Synovectomy: In this surgery, the doctor actually removes the inflamed synovial tissue. Synovectomy by itself is seldom performed now because not all of the tissue can be removed, and it eventually grows back. Synovectomy is done as part of reconstructive surgery, especially tendon reconstruction.

Routine Monitoring and Ongoing Care

Regular medical care is important to monitor the course of the disease, determine the effectiveness and any negative effects of medications, and change therapies as needed. Monitoring typically includes regular visits to the doctor. It may also include blood, urine, and other laboratory tests and x rays.

Osteoporosis prevention is one issue that patients may want to discuss with their doctors as part of their long-term, ongoing care. Osteoporosis is a condition in which bones lose calcium and become weakened and fragile. Many older women are at increased risk for osteoporosis, and their rheumatoid arthritis increases the risk further, particularly if they are taking corticosteroids such as prednisone. These patients may want to discuss with their doctors the potential benefits of calcium and vitamin D supplements, hormone replacement therapy, or other treatments for osteoporosis. (Source: excerpt from Handout on Health Rheumatoid Arthritis: NIAMS)

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Book Excerpts: Treatment of Rheumatoid arthritis

Treatments of Rheumatoid arthritis: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the treatments of Rheumatoid arthritis.

Splenomegaly: Treatment
(In a Page: Signs and Symptoms)

  • Infectious etiologies require appropriate antibiotic regimens
  • Leukemia and lymphoma are treated with combination chemotherapy
  • Systemic lupus erythematosus and rheumatoid arthritis are treated with steroids and/or cytotoxic agents
  • Hemolytic anemia is treated with steroids
  • Splenectomy may be required for patients with traumatic spleen injury with persistent bleeding; patients without a spleen are at increased risk of sepsis and should receive regular pneumococcal and Haemophilus influenzae vaccinations

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Arthritis – Multiple Joints: Treatment
(In A Page: Pediatric Signs and Symptoms)

  • Even though unlikely, if septic arthritis (such as with Neisseria gonorrhoeae) is a possibility, antibiotic treatment should be started immediately
  • Appropriate treatment of malignancy
  • NSAIDs for JRA and spondyloarthropathies as an initial therapy; disease-modifying antirheumatic drugs (DMARDs) such as sulfasalazine and methotrexate, and biologics (e.g., TNF blockers) are added depending on clinical response
  • Specific treatments of other mixed connective tissue diseases depending on their severity
  • Corrective and/or supportive medical/surgical interventions
  • Supportive therapy such as PT and OT to increase range of motion and strength; insoles to correct leg length discrepancy
  • Psychosocial support especially with chronic diseases

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Arthritis – Single Joint: Treatment
(In A Page: Pediatric Signs and Symptoms)

  • If septic arthritis is a possibility, broad-spectrum antibiotic treatment should be started immediately
  • Fractures and most internal derangements require orthopedics involvement
  • Appropriate referral and treatment for malignancy
  • JRA and SpA are usually treated with NSAIDs initially, DMARDs (e.g., sulfasalazine and methotrexate) and biologics (e.g., TNF blockers) are added depending on the degree of inflammation and the response of individual patient
  • Supportive therapy such as PT and OT to increase range of motion and strength; insoles to correct leg length discrepancy
  • Psychosocial support, especially with chronic arthritis

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Neutropenia: Treatment
(In A Page: Pediatric Signs and Symptoms)

  • If a self-limited viral infection is suspected, repeat CBC in 3–4 weeks
  • If cyclic neutropenia suspected, repeat three times per week for 4 weeks
    • If febrile (≥100.4 F [38.0 C]) and/or presenting with acute illness
      –Cultures of blood, urine, sputum if applicable, throat if symptomatic
      –Appropriate broad-spectrum empiric antibiotic therapy
    • Chronic neutropenia
      –May be cyclic or idiopathic (not associated with specific etiology or infection)
      –Granulocyte colony stimulating factor (GCSF) may be helpful
  • Drug-induced neutropenia usually resolves with removal of the offending agent

>>>>

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Splenomegaly: Treatment
(In A Page: Pediatric Signs and Symptoms)

  • Therapy is directed at treatment of underlying disease
  • Splenectomy benefits need to be balanced with risk of postsplenectomy sepsis
    • If splenectomy is performed, immunize at least 10 days prior
      –Pneumococci
      –Haemophilus influenzae, if under 5
      –Meningococcal vaccine
      –Postsurgical penicillin prophylaxis required
    • Febrile illness in patients postsplenectomy is a life-threatening emergency
      –Major risk is overwhelming sepsis from encapsulated bacteria (Streptococcus pneumoniae, H. influenzae, Neisseria meningitidis)
  • Sepsis most frequent in first 5 years after splenectomy

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Splenomegaly: Emergency interventions
(Handbook of Signs & Symptoms (Third Edition))

If the patient has a history of abdominal or thoracic trauma, don’t palpate the abdomen because this may aggravate internal bleeding. Instead, examine him for left upper quadrant pain and signs of shock, such as tachycardia and tachypnea. If you detect these signs, suspect splenic rupture. Insert an I.V. line for emergency fluid and blood replacement, and administer oxygen. Also, catheterize the patient to evaluate urine output, and begin cardiac monitoring. Prepare the patient for possible surgery.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Osteoarthritis: Treatment
(Professional Guide to Diseases (Eighth Edition))

Treatment is aimed at relieving pain, maintaining or improving mobility, and minimizing disability. Medications include nonsteroidal anti-inflammatory drugs, Cox-2 inhibitors and, in some cases, intra-articular injections of corticosteroids. Studies indicate that glucosamine and chondroitin may be useful in controlling symptoms and reducing functional impairment. Injecting artificial joint fluid into the knee can provide relief of pain for up to 6 months.

Effective treatment also reduces stress by weight loss and supporting or stabilizing the joint with crutches, braces, cane, walker, cervical collar, or traction. Exercise, such as through physical therapy, is integral to maintaining or improving joint mobility. Other supportive measures include massage, moist heat, paraffin dips for hands, protective techniques to prevent undue stress on the joints, and adequate rest (particularly after activity).

Surgical treatment, such as one of the following, is reserved for patients who have severe disability or uncontrollable pain:

❑ Arthroplasty (partial or total): replacement of deteriorated part of joint with prosthetic appliance

❑ Arthrodesis: surgical fusion of bones, used primarily in spine (laminectomy)

❑ Osteoplasty: scraping and lavage of deteriorated bone from joint

❑ Osteotomy: change in alignment of bone to relieve stress by excision of wedge of bone or cutting of bone.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Psoriatic arthritis: Treatment
(Professional Guide to Diseases (Eighth Edition))

In mild psoriatic arthritis, treatment is supportive and consists of immobilization through bed rest or splints, isometric exercises, paraffin baths, heat therapy, and aspirin and other nonsteroidal anti-inflammatory drugs. Some patients respond well to low-dose systemic corticosteroids; topical steroids may help control skin lesions. Gold salts and, most commonly, methotrexate therapy are effective in treating both the articular and cutaneous effects of psoriatic arthritis. Antimalarials are contraindicated because they can provoke exfoliative dermatitis.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Rheumatoid arthritis: Treatment
(Professional Guide to Diseases (Eighth Edition))

Salicylates, particularly aspirin, are the mainstay of RA therapy because they decrease inflammation and relieve joint pain. Other useful medications include nonsteroidal anti-inflammatory drugs (such as indomethacin, fenoprofen, and ibuprofen), antimalarials (hydroxychloroquine), gold salts, penicillamine, and corticosteroids (prednisone). Immunosuppressants, such as cyclophosphamide, methotrexate, and azathioprine, are also therapeutic and are being used more commonly in early disease. (See Drug therapy for arthritis.)

Supportive measures include 8 to 10 hours of sleep every night, frequent rest periods between daily activities, and splinting to rest inflamed joints. A physical therapy program including range-of-motion exercises and carefully individualized therapeutic exercises forestalls joint function loss; application of heat relaxes muscles and relieves pain. Moist heat usually works best for patients with chronic disease. Ice packs are effective during acute episodes.

Advanced disease may require synovectomy, joint reconstruction, or total joint arthroplasty.

Useful surgical procedures in RA include metatarsal head and distal ulnar resectional arthroplasty, insertion of a Silastic prosthesis between the metacarpophalangeal and proximal interphalangeal joints, and arthrodesis (joint fusion). Arthrodesis sacrifices joint mobility for stability and pain relief. Synovectomy (removal of destructive, proliferating synovium, usually in the wrists, knees, and fingers) may halt or delay the course of this disease. Osteotomy (the cutting of bone or excision of a wedge of bone) can realign joint surfaces and redistribute stresses. Tendons may rupture spontaneously, requiring surgical repair. Tendon transfers may prevent deformities or relieve contractures. (See When arthritis requires surgery.)

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Juvenile rheumatoid arthritis: Treatment
(Professional Guide to Diseases (Eighth Edition))

Successful management of JRA usually involves administration of anti-inflammatory drugs, physical therapy, carefully planned nutrition and exercise, and regular eye examinations. Both child and parents must be involved in therapy.

Aspirin is the initial drug of choice, with dosage based on the child’s weight. However, other nonsteroidal anti-inflammatory drugs (NSAIDs) may also be used. If these prove ineffective, gold salts, hydroxychloroquine, and penicillamine may be tried. Because of adverse effects, steroids are generally reserved for treatment of systemic complications, such as pericarditis or iritis, that are resistant to NSAIDs. Corticosteroids and mydriatic drugs are commonly used for iridocyclitis. Low-dose cytotoxic drug therapy is currently being investigated. (See Drug therapy for arthritis, pages 367 and 368.)

Physical therapy promotes regular exercise to maintain joint mobility and muscle strength, thereby preventing contractures, deformity, and disability. Good posture, gait training, and joint protection are also beneficial. Splints help reduce pain, prevent contractures, and maintain correct joint alignment.

Surgery is usually limited to soft-tissue releases to improve joint mobility. Joint replacement is delayed until the child has matured physically and can handle vigorous rehabilitation. (See When arthritis requires surgery, page 369.)

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Septic arthritis: Treatment
(Professional Guide to Diseases (Eighth Edition))

Antibiotic therapy should begin as soon as a Gram stain has been done; it may be modified when drug sensitivity of the infecting organism is known. Bioassays or bactericidal assays of synovial fluid and bioassays of blood may confirm clearing of the infection.

Rest, immobilization, elevation, and warm compresses help with pain relief. Analgesics are given for pain, if needed. The affected joint can be immobilized with a splint or put into traction until the patient can tolerate movement.

In severe cases, needle aspiration (arthrocentesis) or surgery may be done under sterile conditions to remove grossly purulent or infected joint fluid. Late reconstructive surgery is warranted only for severe joint damage and only after all signs of active infection have disappeared, which usually takes several months. Recommended procedures include arthroplasty and joint fusion. Prosthetic replacement remains controversial because it may exacerbate the infection, but it has helped patients with damaged femoral heads or acetabula.

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Source: Professional Guide to Diseases (Eighth Edition), 2005

Hypothyroidism in adults: Treatment
(Professional Guide to Diseases (Eighth Edition))

Therapy for hypothyroidism consists of gradual thyroid replacement with levothyroxine (for low T4 levels) and, occasionally, liothyronine (for inadequate T3 levels).

During myxedema coma, effective treatment supports vital functions while restoring euthyroidism. To support blood pressure and pulse rate, treatment includes I.V. administration of levothyroxine and hydrocortisone to correct possible pituitary or adrenal insufficiency. Hypoventilation requires oxygenation and respiratory support. Other supportive measures include fluid replacement and antibiotics for infection.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Splenomegaly: Emergency interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))

If the patient has a history of abdominal or thoracic trauma, don’t palpate the abdomen because this may aggravate internal bleeding. Instead, examine the patient for left-upper-quadrant pain and signs of shock, such as tachycardia and tachypnea. If you detect these signs, suspect splenic rupture. Insert an I.V. line for emergency fluid and blood replacement, and administer oxygen. Catheterize the patient to evaluate urine output, and begin cardiac monitoring. Prepare the patient for possible surgery.

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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Osteoarthritis: Treatment
(Handbook of Diseases)

The goal of treatment is to relieve pain, maintain or improve mobility, and minimize disability. Medications include various nonsteroidal, antiinflammatory drugs (NSAIDs).

UNDER STUDY: COX-2 inhibitors, such as celecoxib, rofecoxiob, and valdecoxib are part of a new class of drugs that have the anti-inflammatory effects of NSAIDS but produce less stomach irritation. Many patients also benefit from such over-the-counter remedies as glucosamine and chondroitin sulfate. However, although many agents are helpful in controlling pain, they don’t appear to stimulate growth of new cartilage.

In some cases, intra-articular injections of corticosteroids given every 4 to 6 months are used to reduce inflammation and pain. Artificial joint fluid, such as Synvisc and Hyalgan, can also be injected into the knee and can result in temporary relief of pain for up to 6 months.

Usually, a 2-week trial period is needed to evaluate the benefit of a particular medication.

Effective treatment also reduces stress by supporting or stabilizing the joint with crutches, braces, cane, walker, cervical collar, or traction. Other supportive measures include massage, moist heat, paraffin dips for hands, protective techniques for preventing undue stress on the joints, adequate rest (particularly after activity) and, occasionally, exercise when the knees are affected.

Surgical treatment, reserved for patients who have severe disability or uncontrollable pain, may include the following:

❑ arthroplasty (partial or total): replacement of the deteriorated part of the joint with a prosthetic appliance

❑ arthrodesis: surgical fusion of bones; used primarily in the spine (laminectomy)

❑ osteoplasty: scraping and lavage of deteriorated bone from the joint

❑ osteotomy: change in alignment of the bone to relieve stress by excision of a wedge of bone or cutting of bone.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Psoriatic arthritis: Treatment
(Handbook of Diseases)

In mild psoriatic arthritis, treatment is supportive and consists of immobilization through joint rest or splints, isometric exercises, paraffin baths, heat therapy, and aspirin and other non-steroidal anti-inflammatory drugs. Some patients respond well to low-dose systemic corticosteroids; topical steroids may help control skin lesions. More severe arthritis requires treatment with more powerful drugs called disease-modifying antirheumatic drugs.

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Source: Handbook of Diseases, 2003

Rheumatoid arthritis: Treatment
(Handbook of Diseases)

Salicylates, particularly aspirin, are the mainstay of RA therapy, because they decrease inflammation and relieve joint pain. Other useful medications include nonsteroidal anti-inflammatories (such as indomethacin, fenoprofen, and ibuprofen), antimalarials (hydroxychloroquine), sulfasalazine, gold salts, and corticosteroids (prednisone). (See Drug therapy for arthritis.)

Immunosuppressants — such as methotrexate, cyclosporine, and azathioprine — are also therapeutic. They’re being used more commonly early in the disease process. Cox-2 inhibitors, such as rofecoxib and celecoxib, significantly reduce the risk of GI bleeding. Cyclophosphamide, which suppresses the immune system and is associated with toxic adverse effects, may be used in patients who have been unsuccessful with other therapies.

UNDER STUDY:  A number of new drugs are becoming popular for RA therapy:  

❑  Etanercept, an injectable, and infliximab, given I.V. every 2 months, inhibit the inflammatory protein tumor necrosis factor.

❑  Leflunomide blocks the growth of new cells.

❑  Anakinra, an injectable, blocks another inflammatory protein, interleukin-1.

Supportive measures include 8 to 10 hours of sleep every night, frequent rest periods between daily activities, and splinting to rest inflamed joints. A physical therapy program, including range-of-motion exercises and carefully individualized therapeutic exercises, forestalls loss of joint function.

Application of heat relaxes muscles and relieves pain. Moist heat usually works best for patients with chronic disease. Ice packs are effective during acute episodes.

Treatment in advanced disease

Advanced disease may require synovectomy, joint reconstruction, or total joint arthroplasty. (See When arthritis requires surgery, page 743.)

Useful surgical procedures in RA include metatarsal head and distal ulnar resectional arthroplasty, insertion of a Silastic prosthesis between MCP and PIP joints, and arthrodesis (joint fusion). Arthrodesis sacrifices joint mobility for stability and relief of pain.

Synovectomy (removal of destructive, proliferating synovium, usually in the wrists, knees, and fingers) may halt or delay the course of the disease. Osteotomy (the cutting of bone or excision of a wedge of bone) can realign joint surfaces and redistribute stresses.

Tendons may rupture spontaneously, requiring surgical repair. Tendon transfers may prevent deformities or relieve contractures. Apheresis may slow down RA or stop it from wor-sening.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Juvenile rheumatoid arthritis: Treatment
(Handbook of Diseases)

Successful management of JRA usually involves administration of an anti-inflammatory, physical therapy, carefully planned nutrition and exercise, and regular eye examinations. The child and his parents must be involved in therapy.

A nonsteroidal anti-inflammatory drug (NSAID) — such as aspirin, ibuprofen, or naproxen — is used to reduce pain and swelling. If this proves ineffective, a disease-modifying antirheumatic drug (DMARD), such as methotrexate, is a useful second-line agent. In addition, gold salts, hydroxychloroquine, auranofin, aurothioglucose, etanercept, or sulfasalazine may be considered. Responses to individual drugs may differ among the various subtypes of JRA. Because of adverse effects, systemic steroids are generally reserved for treatment of systemic complications that are resistant to NSAIDs and DMARDS, such as pericarditis and iritis. However, an intra-articular steroid can be effective in managing pauciarticular and polyarticular JRA.

CLINICAL TIP: Joint rest (by splinting) used for up to 3 days after joint injections with a corticosteroid may improve anti-inflamma-tory response.

Corticosteroids and mydriatics are commonly used for iridocyclitis. Low-dose cytotoxic drug therapy is currently being investigated.

Physical therapy promotes regular exercise to maintain joint mobility and muscle strength, thereby preventing contractures, deformity, and disability. Good posture, gait training, and joint protection are also beneficial. Splints help reduce pain, prevent contractures, and maintain correct joint alignment.

Generally, the prognosis for JRA is good, although disabilities can occur. Surgery is usually limited to soft-tissue releases to improve joint mobility. Joint replacement is delayed until the child has matured physically and can handle vigorous rehabilitation.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Septic arthritis: Treatment
(Handbook of Diseases)

The goals of treatment are to provide oxygen and to treat respiratory distress, if present; to monitor and reverse shock through volume expansion; to treat underlying infections with antibiotic therapy; and to support poorly functioning organs.

Treatment begins with the administration of I.V. fluids and the insertion of a pulmonary artery catheter to check pulmonary circulation and PAWP. Administration of whole blood or plasma may be necessary to help raise the PAWP to a satisfactory level of 14 to 18 mm Hg. A urinary catheter allows accurate measurement of hourly urine output.

The patient may require endotracheal intubation and placement on a ventilator to overcome hypoxia. Adjustments are necessary to promote adequate cellular oxygenation and support hyperdynamic needs.

Antibiotic therapy

Treatment also requires immediate administration of I.V. antibiotics to control the infection. Depending on the organism, an antibiotic combination may be necessary.

Appropriate anti-infectives for causes of septic shock depend on the suspected organism. Other measures to combat infections include surgery to drain and excise abscesses and debridement.

Other drug therapy

If shock persists after fluid infusion, treatment with a vasopressor, such as dopamine, maintains adequate blood perfusion to vital organs. Other treatment includes correction of acidosis and, possibly, I.V. corticosteroids.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Hypothyroidism in adults: Treatment
(Handbook of Diseases)

Therapy for hypothyroidism consists of gradual thyroid hormone replacement with levothyroxine and, occasionally, liothyronine.

Clinical tip  The TSH level is the most reliable marker to follow in primary hypothyroidism. It should be kept within the normal range.

During myxedema coma, effective treatment supports vital functions while restoring euthyroidism. To support blood pressure and pulse rate, treatment includes I.V. administration of levothyroxine and hydrocortisone to correct possible pituitary or adrenal insufficiency. Hypoventilation requires oxygenation and respiratory support.

Other supportive measures include fluid replacement and antibiotics for infection.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Splenomegaly: Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

Prepare the patient for diagnostic studies, such as a complete blood count, blood cultures, and radionuclide and CT scans of the spleen. Assist in managing the underlying disorder and prepare the patient for surgery, as indicated.

Patient teaching

Inform the patient about techniques to avoid infection. Emphasize the importance of complying with the drug therapy regimen and knowing its potential adverse effects. Provide postoperative teaching, if indicated.

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Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007

Splenomegaly: Emergency Actions
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

If the patient has a history of abdominal or thoracic trauma, don’t palpate the abdomen because this may aggravate internal bleeding. Instead, examine the patient for left-upper-quadrant pain and signs of shock, such as tachycardia and tachypnea. If you detect these signs, suspect splenic rupture. Insert an I.V. line for emergency fluid and blood replacement, and administer oxygen. Also, catheterize the patient to evaluate urine output, and begin cardiac monitoring. Prepare the patient for possible surgery.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Splenomegaly: Nursing considerations
(Nursing: Interpreting Signs and Symptoms)

▪ Prepare the patient for diagnostic studies, such as a complete blood count, blood cultures, and radionuclide and computed tomography scans of the spleen.

▪ Monitor vital signs.

▪ Provide measures to treat the underlying disorder.

▪ Take measures to avoid infection.

Patient teaching

▪ Explain the underlying disorder and treatment plan.

▪ Discuss with the patient ways to avoid infection.

▪ Emphasize the importance of complying with drug therapy.

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Source: Nursing: Interpreting Signs and Symptoms, 2007

Fever and Neutropenia: Management
(Pediatric Infectious Disease)

The management of the patient with neutropenia and fever can be divided into three major pathogen groups, discussed in the following sections.

» READ BOOK EXCERPT ONLINE »

Source: Pediatric Infectious Disease, 2004



 » Next page: Alternative Treatments for Rheumatoid arthritis

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