The potential for hepatotoxicity is a well-recognized feature of therapy with a number of DMARDs in rheumatoid arthritis (RA), with methotrexate (MTX) being the most common utilized. Concomitant use of other hepatotoxic agents has the potential to compound the risk of significant liver damage. Among these, isoniazid (INH) is increasingly used in RA patients receiving MTX with evidence of latent tuberculosis infection (LTBI) or prior active tuberculosis for whom TNF inhibitor therapy is planned.
Knuckle Cracking Q & A
Knuckle Cracking Q&A from Johns Hopkins Arthritis Center
Methotrexate Beneficial in Early Undifferentiated Arthritis
Patients with early inflammatory arthritis not meeting classification criteria for rheumatoid arthritis (RA) may have treatment delayed until typical phenotypic features accumulate. Due to the concern for toxicities of DMARDs, patients are often treated with NSAIDs and simple analgesics during this period. However, delay in DMARD treatment in early RA has been shown to result in poorer outcomes, such as irreversible radiographic damage.
Hydroxychloroquine Use May Protect Against the Development of Diabetes in RA Patient
Hydroxychloroquine (Plaquenil) is a commonly used disease modifying anti-rheumatic drug (DMARD) for RA that has known beneficial effects on blood glucose and lipids. However, whether its use can prevent the onset of diabetes in RA patients prescribed it to reduce articular signs and symptoms has not been evaluated.
Do Vitamin D Levels Affect Disease Outcomes in Rheumatoid Arthritis
In addition to its role in calcium hemostasis and bone metabolism, vitamin D also appears to be an important regulator of immune function. However, its role in modulating RA disease activity has not been studied.
Prednisone, but not TNF inhibitors, is associated with an increased risk of serious infection in older RA patients
Older person with rheumatoid arthritis (RA) make up an increasing proportion of those treated with biologic disease modifying anti-rheumatic agents (DMARDs). The safety of these agents may differ for this subgroup of older RA patients, yet effects have generally not been selectively studied in this population.
