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SAARDS
- MEDICATIONS FOR RHEUMATOID ARTHRITIS
There are many kinds of medication that people take when they have
arthritis. Some are easily obtained across the counter from your local
pharmacy, and others have to be prescribed by your doctor. These include
the anti-inflammatory drugs and stronger medications to control
arthritis.
These stronger medications are often called slow acting
anti-rheumatic drugs (SAARDs), disease modifying anti-rheumatic drugs (DMARDs)
or "second line" drugs.
This page is intended to be a general guide to the SAARDs commonly
used to treat rheumatoid arthritis. However, they are also used to treat
other forms of arthritis, for example psoriatic arthritis.
Each SAARD may be given on its own, but if it does not control your
arthritis, a second one may be added. Using more than one SAARD together
is called combination therapy. Your doctor may also prescribe
corticosteroids (Prednisone, Prednisolone, Depo-Medrol, Kenacort) for
the treatment of rheumatoid arthritis.
The slow acting anti-rheumatic drugs include:
SAARDs are used when the non-steroidal anti-inflammatory drugs (NSAIDs)
such as Naprosyn (Naproxen), Voltaren (Diclofenac), or Feldene
(Piroxicam), are not controlling the arthritis. NSAIDs are often use
with SAARDs.
As the name SAARD implies, the benefits are not felt straight away.
It may be 6-10 weeks, sometimes a little longer before you may notice
any benefit from these slow-acting medications. There is often a
reduction in swelling, stiffness and pain together with a decrease in
tiredness. Some of the blood tests that measure inflammation also
improve.
It is important to remember that each person is different and each of
us responds to medications in different ways.
PREGNANCY
Talk to your doctor if you are planning to have a baby, as most
second line medications will need to be stopped before you become
pregnant. SAARDs may be started again once you have finished
breast-feeding.
SIDE EFFECTS
SAARDs tend to have a greater effect on arthritis than NSAIDs and
there are some side effects which are associated with taking this type
of medication. Careful monitoring of the dose, together with regular
routine blood and urine testing will enable any possible problems to be
picked up very quickly and appropriate action taken.
The following is a list of side effects which are sometimes seen in
slow acting medications.
Nausea and/or diarrhoea:
This is usually related to the dose and reducing the dose will often
ease these symptoms.
Rashes:
These may come and go while you are taking SAARDS. If they continue,
the medication is stopped.
Mouth ulcers, sore or bleeding gums:
These may occur with some of the medications and must be reported to
your doctor at once.
Changes in the blood cells:
a) White blood cells: These cells are important for fighting
infection and may be reduced while taking any SAARD.
b) Platelets: These are necessary for blood clotting and may also be
reduced.
Changes in the liver:
Some functions of the liver may be affected whilst taking some
SAARDS.
- Changes in the kidney:
The kidneys can sometimes allow protein and small amounts of blood
to leak into the urine during treatment.
HOW OFTEN ARE TESTS DONE?
When the medication is started blood tests (full blood count, liver
and kidney function) and urine testing for protein and blood may be
performed weekly or less frequently depending on what SAARD you are
taking.
Your doctor, (either your GP or specialist) will organise the tests
for you. Blood and urine tests are performed either at the surgery or at
a nearby collection centre. Results are sent to your doctor.
RECORDING YOUR RESULTS
Commonly you will be given a booklet which contains information on
the dosage of medication, and details of each blood and urine sample
tested. In this way it is easy for your doctor to see the information he
needs to know, Any changes in the tests will also show if your doctor
needs to take any action. It is important that you keep this booklet
with you and take it each time you visit your doctor.
Please remember - the benefits that can be gained from
taking slow acting anti-rheumatic drugs outweigh the possible side
effects. Simple precautions on a regular basis, as mentioned, will
prevent side effects from becoming a problem.
Following is information on each particular SAARD
GOLD
This may be given by injection or as tablets.
SIDE EFFECTS FROM EITHER INJECTED OR ORAL GOLD
Skin rashes and /or general itchiness.
Sore gums or mouth ulcers.
Diarrhoea or loose bowel motions - this is more common when taking
oral gold.
Reduction of white blood cells and platelet numbers.
Changes in the kidney which may result in protein or blood in the
urine.
- Changes in the liver.
SPECIAL PRECAUTIONS WHILE TAKING GOLD
Blood and urine tests should be carried out before each injection
in early stages of treatment. These will be organised by your
doctor.
Mention to your doctor any unusual feelings or symptoms.
Take your gold record booklet with you each time you see your
doctor.
- Gold tablets are best taken with food.
SULPHASALAZINE
Salazopyrin-EN
Taken as a table
The dosage depends on your response to treatment.
At first, dosage is usually 500 mg a day (one tablet)
The dosage is increased slowly over a number of weeks until
the full dose is reached (often 4-6 tablets daily).
- The dosage may be changed from time to time depending on how
your arthritis responds, and if you have any side effects.
SIDE EFFECTS OF SULPHASALAZINE
Nausea and indigestion.
Dizziness and headache.
Skin rashes.
Reduction of white blood cells and platelet numbers in your blood.
This is a rare side effect.
Slight changes in the liver.
May stain contact lenses yellow, particularly soft lenses.
Urine may have an orange colour.
May reduce the sperm count in men and could cause temporary
infertility. This effect only occurs while taking sulphasalazine.
The sperm count returns to normal once the medication is stopped.
- There is no effect on fertility in women.
SPECIAL PRECAUTIONS WHILE TAKING SULPHASALAZINE
Routine blood tests will be performed. Your doctor will indicate
how often he/she wants you to have your blood tested.
Tell your doctor of any symptoms you may have. A change of dosage
of sulphasalazine may ease the symptom
- Always take your medication after meals and use the enteric coated
EN brand.
D-PENICILLAMINE
D-PENAMINE
Taken as a tablet.
Dosage is usually once or twice daily with starting dose
between 125 - 250 mg daily.
Dosage is increased gradually until the full dose is reached.
This is usually between 500-1000mg per day.
Dosage may be changed by your doctor depending on how your
arthritis responds, or whether you have any side effects.
- D-Penicillamine is not an antibiotic and an allergy to
penicillin should not prevent you from taking it.
SIDE EFFECTS OF D-PENICILLAMINE
SPECIAL PRECAUTIONS WHILE TAKING D-PENICILLAMINE
Routine blood and urine tests which will be arranged by your
doctor.
It is important to take D-Penicillamine on an empty stomach as
food interferes with its absorption into the body. Take the tablets
1/2 hour before a meal, or at least two hours following a meal.
Take your D-Penicillamine record booklet each time you visit your
doctor.
- Antacids and iron tablets can slow the absorption of
D-Penicillamine. Take these medications at different times of the
day to D-Penicillamine.
METHOTREXATE
Ledertrexate
Taken as a tablet
This medication is taken once a week with a usual starting
dose of 2.5-7.5 mg. It is usually taken on the same day each
week, with the dose slowly increased
The dosage may be changed by your doctor, depending on how
well your arthritis responds and whether you have side effects
- It is best taken with food to avoid stomach upsets.
SIDE EFFECTS OF METHOTREXATE
Mouth ulcers or sore gums.
Nausea - this usually only lasts 24 hours following medication.
Reduction in white blood cells and platelet numbers in the blood.
- Changes in the liver.
SPECIAL PRECAUTIONS WHILE TAKING METHOTREXATE
Only take the medication weekly (never daily).
Routine regular blood tests, as arranged by your doctor.
It is very important to limit your intake of alcohol while taking
Methotrexate. Your doctor will advise you what is considered an
acceptable amount.
- It is very important to avoid pregnancy while taking methotrexate.
AZATHIOPRINE
SIDE EFFECTS OF AZATHIOPRINE
SPECIAL PRECAUTIONS WHILE TAKING AZATHIOPRINE
ANTI-MALARIALS
SIDE EFFECTS OF PLAQUENIL
Skin rashes, particularly on the areas exposed to the sun.
May affect the eyes. This is unlikely at the dosages used today.
- Stomach effects such as nausea, cramps, diarrhoea.
SPECIAL PRECAUTIONS WHILE TAKING PLAQUENIL
Regular eye check, usually every six months. Your doctor will
refer you to an eye specialist.
Use 15+ blockout on the skin, and long sleeved clothing when
exposed to the sun.
Use a hat and good quality sun glasses.
- Plaquenil is best taken with meals.
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