Thursday, December 22, 2011
How is it treated?
To prevent any more damage to children, they should be sent as soon as possible to the pediatric rheumatologist is the specialist who has more experience in the treatment and monitoring of disease. The child is a growing and developing, which could suffer lasting consequences different from those found in adults.
Every child diagnosed with juvenile rheumatoid arthritis should be treated with medication and be referred for physiotherapy from the beginning of the diagnosis. If possible take the help of an occupational therapist, nutritionist and, where necessary, a psychologist.
How is drug treatment?
The initial drug treatment depends on the type of commitment that the child has.
If the compromise is a few joints and joints are not included poor prognosis, such as coxofemurais and wrists, it is customary to use only non-steroidal anti-inflammatory drugs for a period of 3 to 4 weeks to evaluate the clinical response. When this measure is not satisfactory may be required to present the introduction of a second medication, which varies according to the experience of the specialist.
However, when the child has from the beginning multiple joints involved, may require the early introduction of a more potent drugs such as methotrexate.
b) Systemic manifestations:
In cases where the manifestations are predominantly systemic, with involvement of the pericardium or persistent fever unresponsive to anti-inflammatory, it is necessary to use high doses of corticosteroids.
It is important to emphasize that corticosteroids are not drugs of choice for the treatment of arthritis, ie, the joint involvement. As far as possible avoid their introduction.
c) Eye complications:
In cases of ocular involvement, it is recommended to use eye drops and regular monitoring with the ophthalmologist. If the inflammation persists may require the use of oral corticosteroids or even immunosuppressive medications.
There are new drugs for the treatment of disease?
New drugs are emerging for the treatment of patients with chronic arthritis, however, very few have been studied in children. Etanercept is one of the medications being evaluated in juvenile rheumatoid arthritis, but only for patients with polyarticular or systemic types who did not respond to currently available medications. Although preliminary, the results have been very promising.
When you stop treatment?
The duration of treatment is always unpredictable and will depend on the patient's response to medication and physiotherapy. Approximately 50% of patients maintained some activity of the disease after a follow-up period from 50 to 10 years. In such cases treatment should be maintained until they get the clinical and laboratory remission, or until the child has no more signs of disease activity for at least one year.
What are the nutritional care?
Special attention should be given to supply the patient with juvenile rheumatoid arthritis. There are frequent nutritional disorders determined as much by chronic food for errors resulting from ignorance of his own family about the child's needs.
It is important that, as far as possible, the family of a patient with juvenile rheumatoid arthritis have the guidance of a nutritionist, at least initially. The diet of these children must be balanced with a protein, calories, iron and trace elements, tailored to the needs of a growing and be a chronic inflammatory disease.
How important is physical activity?
Physical activity should be encouraged in all cases because it is essential for maintaining joint function. Children with juvenile rheumatoid arthritis should not sit still and much less confined to bed.
The restriction on their activities can occur especially in the onset, the presence of pain. Even so, the child should be encouraged to walk and participate in particular activities of physiotherapy and occupational therapy when possible.
While there may be many difficulties in daily life of some patients, such as in school (curiosity and discrimination from peers, having to climb the ladder to get in the classroom, can not run in the playground etc..), They should be encouraged to maintain normal activities of a child. Often, you need the support of teachers and guidance counselor's own so that difficulties do not become too heavy for the child and do give up social life.
What is the role of the family?
The role of family is fundamental to better child's development. The support and love from parents the support they need to feel safe and able to overcome the disease and the limitations imposed by it. However, parents should be careful not to confuse love with guilt and overprotection, which only impede the progress of patients.
Friday, November 19, 2010
In the study, 611 people with moderate to severe rheumatoid arthritis who had an inadequate response to at least one other drug were randomly assigned to one of two doses of tasocitinib or placebo.
Among the findings:
- A total of 66% of patients who received the higher dose of tasocitinib had at least a 20% improvement in disease activity and symptoms after three months of treatment, compared with 60% of those given the lower dose and 27% of those who received a placebo.
- Scores on a questionnaire that asks about dressing, arising, eating, walking, hygiene, reach, grip, and activities improved more than twice as much in people taking either dose of tasocitinib, compared with placebo.
But for the third primary study goal, remission according to the Disease Activity Score-28 (DAS-28) at three months, tasocitinib did not offer a substantial advantage at either dosage relative to placebo.
DAS-28 scores take into account such measures as the number of joints tender to the touch and the number of swollen joints. Using this measure, 10% of patients on the higher tasocitinib dosage, 6% on the lower dose, and 4% on placebo were in remission at three months. But the difference in remission rates did not reach what doctors call statistical significance, Fleischmann tells WebMD. He says he received consulting fees and research support from Pfizer, which makes the drug and funded the new study.
Saturday, August 14, 2010
The FDA has added information on severe liver injury to the boxed warning for Arava (leflunomide, Sanofiaventis)—a drug used to treat rheumatoid arthritis—to highlight the risk for severe liver injury in patients using this drug and how this risk might be reduced. The FDA previously required a boxed warning stating that leflunomide was contraindicated in pregnant women or women of childbearing potential who were not using reliable contraception.
Although a bolded warning statement on severe liver injury was added to the leflunomide drug label in 2003, the FDA determined that information on severe liver injury should be included in the boxed warning to highlight the importance of appropriate patient selection before starting treatment, and monitoring once treatment has begun.
The decision to add information on severe liver injury to the boxed warning was based on the FDA’s 2010 review of adverse event reports that identified 49 cases of severe liver injury, including 14 cases of fatal liver failure, between August 2002 and May 2009. In this review, the greatest risk for liver injury was seen in patients taking other drugs known to cause liver injury and patients with pre-existing liver disease.
Sunday, July 25, 2010
Between 80-90 percent of the participants reported at least one negative aspect of self-administration, the study RAISE, which was developed to gain a better understanding of the concerns of these patients using these devices.
Although more than half of patients consider the devices easy to use self-injection, over a third admitted to not knowing if the treatment is administered correctly
The study said 36 percent of patients questioned indicated pain and redness at the injection site, 10 percent admit I miss a dose because of the pain. In addition, 10 percent of patients fail treatment have thought the same reason.