Pharmacologic Profile

General Use

Antirheumatics are used to manage symptoms of rheumatoid arthritis (pain, swelling) and in more severe cases to slow down joint destruction and preserve joint function. NSAIDs, aspirin, and other salicylates are used to manage symptoms such as pain and swelling, allowing continued motility and improved quality of life. Corticosteroids are reserved for more advanced swelling and discomfort, primarily because of their ↑ side effects, especially with chronic use. They can be used to control acute flares of disease. Neither NSAIDs nor corticosteroids prevent disease progression or joint destruction. Disease-modifying antirheumatics drugs (DMARDs) slow the progression of rheumatoid arthritis and delay joint destruction. DMARDs are reserved for severe cases because of their toxicity. Several months of therapy may be required before benefit is noted and maintained. Serious and frequent adverse reactions may require discontinuation of therapy, despite initial benefit.

General Action and Information

Both NSAIDs and corticosteroids have potent anti-inflammatory properties. DMARDs work by a variety of mechanisms. See individual agents, but most work by suppressing the autoimmune response thought to be responsible for joint destruction.

Contraindications

Hypersensitivity. Patients who are allergic to aspirin should not receive other NSAIDs. Corticosteroids should not be used in patients with active untreated infections.

Precautions

NSAIDs and corticosteroids should be used cautiously in patients with a history of GI bleeding. Corticosteroids should be used with caution in patients with diabetes. Many DMARDs have immunosuppressive properties and should be avoided in patients for whom immunosuppression poses a serious risk, including patients with active infections, underlying malignancy, and transplant recipients.

Interactions

NSAIDs may diminish the response to diuretics and other antihypertensives. Corticosteroids may augment hypokalemia from other medications and ↑ the risk of digoxin toxicity. DMARDs ↑ the risk of serious immunosuppression with other immunosuppressants. Live vaccines should not be given concurrently with DMARDs.

Nursing Implications

Assessment

• Assess patient monthly for pain, swelling, and range of motion.

Potential Nursing Diagnoses

• Chronic pain (Indications)
• Deficient knowledge related to disease processes and medication regimen

Implementation

• Most agents require regular administration to obtain maximum effects.

Patient/Family Teaching

• Instruct patient to contact health care professional if no improvement is noticed within a few days.

Evaluation/Desired Outcomes

• Improvement in signs and symptoms of rheumatoid arthritis.