Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0042384 (vasculitis)
 20,525 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Disease-modifying antirheumatic drugs are used to modify or alter the rheumatoid arthritis disease process. Disease-modifying antirheumatic drugs do not demonstrate the characteristic analgesic, antipyretic, and anti-inflammatory actions of the nonsteroidal anti-inflammatory drugs, since weeks or months of treatment are required before clinical benefit is observed. Although they have not been proved to delay, prevent, or reverse articular damage, therapy with disease-modifying antirheumatic drugs, when successful, is associated with decreased pain and joint swelling and improved function. Disease-modifying antirheumatic drugs and cytotoxic agents should not be considered as routine treatment for patients with rheumatoid arthritis. Before disease-modifying antirheumatic drug therapy is implemented, an optimal basic program of physical therapy, rest, and nonsteroidal anti-inflammatory drugs should be implemented, and it must be documented that the patient still has sufficient disease to justify the costs, risks, and benefits of these treatments. Drugs that are approved by the Food and Drug Administration (FDA) are preferred over nonapproved drugs. Hydroxychloroquine, parenteral gold salts, oral gold, D-penicillamine, and the cytotoxic drug azathioprine are the FDA-approved disease-modifying antirheumatic drugs for use in rheumatoid arthritis. Many, not all, rheumatologists would employ hydroxychloroquine as the first-choice disease-modifying antirheumatic drug in patients who have early, mild, and nonerosive disease; treatment should be continued for six months before being abandoned for lack of efficacy, and appropriate ophthalmologic examination every four to six months is indicated. An alternative would be auranofin, whose efficacy approaches that of parenteral gold, yet may be safer. For patients who have severe active rheumatoid arthritis, especially with erosive changes, parenteral gold salts are usually a first choice. D-penicillamine is also effective in controlling the signs and symptoms of rheumatoid arthritis, but serious toxicity may occur. Azathioprine might be considered a competitor to D-penicillamine, although the FDA approval restricts its use to patients who have failed gold therapy. Two cytotoxic drugs that are not FDA approved are methotrexate and cyclophosphamide. Methotrexate can be very effective, but its side effects, particularly pulmonary and hepatic, must be carefully monitored. Cyclophosphamide is generally considered too toxic for use in patients with rheumatoid arthritis, although it may be helpful in patients with systemic rheumatoid vasculitis or patients who have failed all other therapies.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Role of disease-modifying antirheumatic drugs versus cytotoxic agents in the therapy of rheumatoid arthritis. 305 55

A patient with classic rheumatoid arthritis who developed leukocytoclastic vasculitis is described. Low-dose methotrexate produced prompt healing of the skin lesions. After discontinuation of methotrexate, the lesions recurred, with resolution after a second course of the drug. Methotrexate may be useful in the treatment of cutaneous vasculitis associated with rheumatoid arthritis.
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PMID:Low-dose methotrexate therapy for cutaneous vasculitis of rheumatoid arthritis. 362 79

Pulmonary involvement is one of the extra-articular manifestations of rheumatoid arthritis (RA) and includes pleurisy, parenchymal nodules, interstitial involvement, and airway disease. Rheumatoid pulmonary vasculitis is rare. Pulmonary disease also may be observed as a toxic event consequent to treatment for RA. Although RA is more common in women, rheumatoid lung disease occurs more frequently in men who have long-standing rheumatoid disease, positive rheumatoid factor and subcutaneous nodules. Pleural involvement, usually asymptomatic, is the most common manifestation of lung disease in RA and may occur concurrently with pulmonary nodulosis or interstitial disease. The clinical features and course of pulmonary fibrosis in RA are similar to those of idiopathic pulmonary fibrosis. Bronchiolitis obliterans organizing pneumonia (BOOP), which has been recently described in RA patients, has nonspecific clinical features. The histological patterns correspond to proliferative bronchiolitis in the airway and organizing pneumonia in the alveoli. Obstructive lung disease in RA includes obliterative bronchiolitis (OB) and bronchiectasis. OB is an acute illness characterized histologically by a constrictive bronchiolitis. It may be idiopathic or induced by D-penicillamine or intramuscular gold compounds. Methotrexate (MTX)-pneumonitis is an uncommon complication of MTX treatment. Its clinical presentation is not specific, and diagnosis must be made after exclusion of other causes of pulmonary diseases. It is uncertain if preexisting lung disease predisposes RA patients to MTX-pneumonitis. Treatment of lung disease in RA is empirical. Corticosteroids are usually administered and immunosuppressive drugs are often added when pulmonary disease progresses and/or steroid side-effects appear.
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PMID:Pulmonary involvement in rheumatoid arthritis. 774 Mar 4

A case is reported in which a patient with a rheumatoid factor-negative rheumatoid arthritis developed rheumatoid nodules in the penis during treatment with methotrexate. The development of rheumatoid nodules in seronegative rheumatoid arthritis patients is extremely rare. An acceleration of rheumatoid nodules in methotrexate-treated rheumatoid arthritis patients is reported in literature. Regarding the case reported here, we propose a causal relationship between methotrexate-treatment and the development of rheumatoid nodules in our patient. Methotrexate should not be the preferential treatment for patients with rheumatoid arthritis developing rheumatoid nodules and suffering from vasculitis.
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PMID:Rheumatoid nodules located in the penis of a methotrexate-treated patient with rheumatoid arthritis. 781 Feb 40

Immunosuppressants are applied clinically on vasculitis. Cyclophosphamide, azathioprine, and methotrexate are used most often. Other immunosuppressants, such as bredinin, FK506, monoclonal antibody, and adhesion molecule are studied in laboratory level or in small group clinical trial. In combination therapy, immunosuppressants are used with corticosteroids, which are the first choice drug on angitis. Methotrexate is administered as intermittent manner. Since immunosuppressants have side effects including oncogenicity and immunotoxicity, clinicians have to pay much attention on clinical course of the patients with vasculitis.
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PMID:[Application of immunosuppressants for therapy of patients with vasculitis]. 793 8

A patient with urticarial vasculitis unresponsive to all treatments except systemic corticosteroids responded completely to low-dose oral methotrexate, allowing withdrawal of corticosteroids. Methotrexate is a proven treatment for other immunologic diseases, and low doses seem to carry an acceptable safety profile. Its use in urticarial vasculitis may be appropriate in selected patients.
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PMID:Methotrexate for urticarial vasculitis. 829 48

Non-steroidal antiinflammatory drugs (NSAIDs), corticosteroids and disease modifying antirheumatic drugs are commonly used for the treatment of the inflammatory rheumatic diseases. In addition to their antiinflammatory effects, many of these drugs influence an otherwise impaired immune system, which may result clinically in decreased resistance to infection and/or increased incidence of malignancies, in stimulation of the immune response and autoimmune diseases, or in allergy or hypersensitivity. Only corticosteroids increase considerably the risk of infections, immunosuppressive agents-at the low doses used in rheumatology-do not have this effect. Although the data are conflicting, neoplasms, especially leukaemias and lymphomas seem to develop more frequently during immunosuppressive treatment. Methotrexate, most commonly used nowadays in the early stage of joint disease, does not seem to increase the risk of malignancies. Although several drugs may induce autoimmune diseases, d-penicillamine is the commonest inducer. NSAIDs have the greatest propensity to produce allergy or hypersensitivity, causing various cutaneous, renal, and bronchial symptoms, and rarely vasculitis. Methods for the measurement of their plasma concentrations are available for most of the drugs, although not routinely used. Clinical vigilance, regular check-ups and full knowledge of side effects are crucial in the diagnosis of drug-induced immunotoxicity, especially because the symptoms and signs of immunotoxicity may mimic the naturally occurring features of the underlying disease.
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PMID:Clinical immunotoxicity of antirheumatic drugs. 898 9

Although GS and CYC have been important agents in improving the outcome and survival of patients with systemic vasculitis, they carry their own risk of drug-induced morbidity and mortality. It has also become apparent that these medications are not the final answer in disease management because some forms of vasculitis have the potential to relapse or be treatment resistant. For these reasons, the pursuit of effective, less toxic therapeutic alternatives is critical. Initial results from the use of MTX in systemic vasculitis have been encouraging. Although drug-related toxicity and disease relapse have still been found to occur, MTX appears to be a valuable addition in the treatment of vasculitis. Further studies will be necessary to determine the optimal way that this agent may be used to safely and effectively manage vasculitic disease.
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PMID:Methotrexate use in systemic vasculitis. 936 Nov 58

Juvenile dermatomyositis (JDM) is a multisystem disease characterized by acute and chronic lymphocytic inflammation of the skeletal muscle and skin. The disease is marked early in its course by the presence of a vasculopathy or vasculitis, and later by the development of calcinosis. Research has focused on the epidemiology, etiology, and pathogenesis of the disease with, until more recently, limited therapeutic interventions. This article highlights treatment regimens, both traditional and more recent interventions. Traditional treatment for JDM includes high dose corticosteroid treatment with additional agents used in resistant disease or children with unwarranted adverse effects. Traditional therapy begins with daily oral corticosteroids, with intravenous corticosteroids utilized in severe disease; however, recent data suggests that short-term use of intravenous corticosteroids will allow a short-term improvement in strength, with no long-term change in outcome. More recent investigations suggest that early intervention with additional immunomodulatory agents will allow for a faster recovery, with less medication and disease sequelae. Use of methotrexate as an agent early in the disease course is becoming common place. Methotrexate, in conjunction with oral corticosteroids, allows a rapid improvement in symptoms, and allows for a more rapid reduction in corticosteroid dose. Methotrexate is considered as a steroid sparing agent, whether oral or intravenous corticosteroids are used. Additional immunomodulatory agents include the use of cyclosporine with or without methotrexate. Intravenous immunoglobulin has been reported to have benefit in resistant disease. There are exciting new agents which have great potential in treating JDM. Many of these agents are termed biologics and are being tested in adult myositis and juvenile arthritis. These include tumor necrosis factor (TNF)-alpha inhibitors, such as a chimeric monoclonal antibody to TNF-alpha, and a recombinant soluble human TNF receptor (p75)-Fc fusion protein. Many other new biological agents are also being tested in myositis.
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PMID:Juvenile dermatomyositis: recognition and treatment. 1199 36

Ideally, immunosuppressive drugs would not be necessary in pregnancy. However, in connective tissue disease (especially systemic lupus erythematosus, SLE) vasculitis, and sometimes antiphospholipid antibody syndrome, their use is necessary both to protect the health of the mother and to insure the success of the pregnancy. The more commonly used drugs will be reviewed, with an emphasis on human data, when available. Methotrexate and leflunamide will not be considered, for they should never be used in pregnancy.
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PMID:Immunosuppressive drug use in pregnancy. 1276 71


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