Drugs and arthritis. Drug information Drugs and arthritis

Transcript

1 Drug information Drugs and arthritis Drugs and arthritis This leaflet provides information on drugs and arthritis and will answer any questions you have about the treatment. Arthritis Research UK produce and print our booklets entirely from charitable donations.

2 How are drugs used to treat arthritis? Arthritis means inflammation of joints. Many different drugs are used in its treatment. Some drugs, for example painkillers, are used to reduce symptoms, while others treat the underlying cause of the condition. Different drugs often work in different ways, so they can be used together. Your doctor, rheumatology nurse specialist or pharmacist will be able to give you advice on which drugs are best for you.

3 Arthritis Research UK Drugs and arthritis What s inside? 2 What drugs are used to treat arthritis? Painkillers (analgesics) Table 1: Groups of drugs used to treat arthritis Non-steroidal anti-inflammatory drugs (NSAIDs) Disease-modifying anti-rheumatic drugs (DMARDs) Steroids (corticosteroids) 6 Important points to remember about drug treatment 6 General points to remember about all drugs 8 Where can I get more information? There s a handy notes section in the back of this booklet where you can keep a record of all the drugs you take. 1

4 What drugs are used to treat arthritis? Different types of arthritis are treated with different drugs. If you have rheumatoid arthritis, for example, most of your treatment will be very different to someone who has osteoarthritis. Many drugs can help significantly and may stop your arthritis getting worse. Some drugs are available to buy over the counter from supermarkets and chemists, but other, stronger drugs are only available on prescription from your healthcare team. Drugs used to treat arthritis can be divided into four broad groups: 1. Painkillers (analgesics) Painkillers are used for many types of arthritis. Some are stronger than others, the strongest being opioid painkillers (opioid is a scientific name showing that these drugs belong to the same chemical family). The three different types of painkiller are: simple non-opioid painkillers (for example paracetamol) compound painkillers, a combination of drugs in one tablet (for example paracetamol and codeine are combined to make co-codamol) opioid analgesics (for example codeine) since these preparations usually contain a higher dose of opioid than the compound painkillers, they re stronger but may have more side-effects. Simple non-opioid painkillers and some compound painkillers are available over the counter. They have few sideeffects, although compounds made from codeine can cause constipation and nausea. Stronger compound painkillers and opioid painkillers are only available on prescription. Paracetamol is usually the first treatment recommended for pain caused by osteoarthritis. It s not an anti-inflammatory drug, so it may not be helpful for inflammatory arthritis on its own. 2 The drugs you take will depend on the type of arthritis you have, although some drugs are used to treat many conditions.

5 Arthritis Research UK Painkillers Table 1 Groups of drugs used to treat arthritis What type of drug is it? What do they do? What are they used to treat? Painkillers e.g. paracetamol, codeine, co-codamol Reduce pain by managing the symptoms of the condition Most types of arthritis, including osteoarthritis Non-steroidal anti-inflammatory drugs (NSAIDs) e.g. aspirin, ibuprofen, celecoxib Disease-modifying anti-rheumatic drugs (DMARDs) e.g. methotrexate, sulfasalazine Biological therapies are a newer group of DMARDS which are used in people who haven t responded to older DMARDs or who can t take those due to side-effects Steroids e.g. prednisolone Reduce joint inflammation and pain by managing the symptoms of the condition Reduce inflammation (which reduces pain) by altering the underlying condition Reduce inflammation (which reduces pain) by altering the underlying condition Most types of arthritis, including inflammatory conditions such as rheumatoid arthritis, gout, lupus Inflammatory arthritis, including rheumatoid arthritis, lupus and juvenile idiopathic arthritis (JIA) Inflammatory arthritis including rheumatoid arthritis, gout, lupus, polymyalgia rheumatica (PMR) Steroid injections may be used for osteoarthritis 3

6 You can buy some painkillers and NSAIDs over the counter, but stronger types are only available on prescription. 2. Non-steroidal antiinflammatory drugs (NSAIDs) NSAIDs reduce inflammation and pain. They re used for many different types of arthritis, often with other drugs. There are several different kinds of NSAIDs, so if one doesn t work for you, you can try another. NSAIDs are available in a number of different forms, including: tablets or capsules, sometimes in slowrelease preparations (this means the drug is gradually absorbed by the body a little at a time, rather than all at once) suppositories which you can insert into the back passage creams or gels which you can rub onto the affected area. Some NSAIDs, like aspirin and ibuprofen, are available over the counter. Stronger forms are only available on prescription. NSAIDs can damage the lining of the stomach and cause bleeding, particularly if taken in higher doses or over a long period. The COX-2-specific NSAIDs (also known as coxibs) are less likely than standard NSAIDs to cause stomach-related side-effects. Your doctor may prescribe a drug called a proton pump inhibitor along with the NSAID to help protect your stomach. NSAIDs are associated with a small increased risk of heart attack and stroke, and they re not generally recommended during pregnancy. NSAIDs should be used with caution. You should only continue to use them if they re controlling your symptoms. You shouldn t take them if you have a history of indigestion or stomach ulcers. 3. Disease-modifying antirheumatic drugs (DMARDs) DMARDs are mainly used in the treatment of rheumatoid arthritis but also in some other rheumatic conditions. Examples include methotrexate, sulfasalazine, hydroxychloroquine and leflunomide. They reduce pain, swelling and stiffness, but they may take several weeks to work, so you ll need to keep taking them even if they don t seem to have an effect at first. If you don t respond to one of these drugs, or if you develop any sideeffects, then your doctor may try one of the others. Often two or more of these drugs are used together this is called combination therapy. Most DMARDs act by suppressing the immune system, which can cause sideeffects. Some can also have side-effects 4

7 Arthritis Research UK Drugs and arthritis on other parts of the body such as the liver. People taking DMARDs therefore need careful monitoring with regular blood tests. Biological therapies are a newer group of DMARD which includes drugs such as abatacept and rituximab. The anti- TNF drugs (for example adalimumab, etanercept and infliximab) are also classed as biological therapies. They re given by injection or infusion, and they can reduce joint inflammation. They re currently only being used in people who haven t responded to other diseasemodifying drugs. Because some DMARDs can affect your immune system, they can increase your risk of infection. It s important to speak to your doctor or rheumatology nurse specialist if you: develop symptoms of infection (for example a sore throat or fever) come into contact with someone with chickenpox or shingles develop chickenpox or shingles. Side-effects vary and can take some time to develop, so it s important to speak to your doctor or rheumatology nurse specialist about this. 4. Steroids (corticosteroids) Steroids are very effective in controlling inflammation. They may be taken as tablets or injected into a muscle, joint or vein, depending on why they re being prescribed. For example, if one particular joint is inflamed, your doctor may inject it with a steroid preparation. If steroids are used for many months or in high doses, they produce side-effects, so doctors try to use them in as low a dose as possible or prescribe other drugs to take with the steroids that help to protect against side-effects. Taking steroids can cause osteoporosis (thinning of the bones), and for this reason your doctor may prescribe treatment to protect your bones while you re taking steroids. What drugs you re prescribed will depend on your condition and your symptoms. You may be prescribed a drug that doesn t come under one of these groups, for example if you have gout you may be given colchicine to prevent an acute attack. Arthritis Research UK provides individual booklets on specific conditions, which will give more information on different treatments, and your doctor or rheumatology nurse specialist will also be able to give you advice on the drugs you might be prescribed. 5

8 Important points to remember about drug treatment Because different drugs work in different ways, you may need to take more than one drug for your arthritis (combination therapy). If you have rheumatoid arthritis, a common combination is a painkiller, an NSAID and one or more DMARDs. If one drug doesn t work, it doesn t mean that you won t respond to another. Similarly, if you develop sideeffects with one drug, it doesn t mean that you ll develop the same problems with another drug. Some drugs, including several used in the treatment of rheumatoid arthritis, don t work immediately. Some can take several months to have an effect. While most drugs are taken by mouth (orally), some come in the form of a suppository or are given by injection. For example, gold is usually given by a deep injection into a muscle (intramuscular injection), adalimumab is given as an injection just under the skin (subcutaneous injection) and infliximab is given as a drip into a vein (intravenous infusion). Some drugs are started at a low dose which is gradually increased (for example methotrexate). Other drugs are started at a higher dose and, depending on how you respond to the drug, the dose may be reduced (for example gold injections). General points to remember about all drugs Keep a list of all the drugs you take (including those bought over the counter) so that you can tell your doctor. Follow the instructions that your doctor or pharmacist gives you about taking your treatment. For example, anti-inflammatory tablets should be taken with or after food. If the instructions aren t clear, ask for an explanation. If you experience any side-effects, tell your doctor or rheumatology nurse specialist. Don t take over-the-counter drugs or complementary medicines (including herbal remedies and nutritional supplements) without discussing it with your doctor first. They may not be safe for you. For example, some over-the-counter medication contain anti-inflammatory drugs, which can cause problems or react with the drugs that your doctor prescribes. Never share your medication with others. The drugs may harm them, even if their symptoms are the same as yours. Keep medicines out of the reach of children. You shouldn t drink alcohol when you re taking certain drugs. If in doubt, ask your doctor. 6

9 Arthritis Research UK Drugs and arthritis If you miss a dose, don t try to catch up by taking extra tablets. If you re worried, ask your doctor or pharmacist. Drugs are only one aspect of the treatment of arthritis. Other helpful treatments include physiotherapy, occupational therapy and foot care (chiropody/podiatry), as well as different self-help measures. Arthritis Research UK provide a range of booklets on specific conditions which include information on drug treatments. We also have information on specific drugs in our selection of drug leaflets. For more information, please read the booklets and leaflets that are relevant to your condition. If you re in any doubt about the drug treatment for your arthritis, ask your doctor, rheumatology nurse specialist or pharmacist for advice. Always talk to your doctor or rheumatology nurse specialist before taking over-the-counter drugs because they may interact with your prescribed medication. Keep a list of all the drugs you re using and the dosage so you can let any other doctor treating you know what you already take. 7

10 If you have any concerns about your treatment, speak to your doctor, rheumatology nurse specialist or pharmacist. Where can I get more information? Arthritis Research UK is the charity leading the fight against arthritis. We do this by funding high-quality research, providing information and campaigning. We publish over 60 information booklets which help people to understand more about their condition, its treatment, therapies and how to help themselves. If you would like any further information about your treatment, Arthritis Research UK publish individual patient information leaflets about drugs. These include: Abatacept Adalimumab Allopurinol Amitriptyline Azathioprine Certolizumab pegol Ciclosporin Cyclophosphamide Drugs for osteoporosis Etanercept Febuxostat Gold injections Golimumab Hydroxychloroquine Iloprost Infliximab Intravenous immunoglobulin Leflunomide Local steroid injections Methotrexate Mycophenolate Non-steroidal anti-inflammatory drugs Painkillers Rituximab Steroid tablets Sulfasalazine Tocilizumab 8

11 Arthritis Research UK Drugs and arthritis Notes Record your information here to help you manage your treatment: What am I taking? When/how often? What dosage (if applicable)? Hospital/clinic address: 9

12 ΙΩΑΝΝΗΣ Γ. ΡΟΥΤΣΙΑΣ ΜΙΚΡΟΒΙΟΛΟΓΙΚΟ ΔΙΑΓΝΩΣΤΙΚΟ & ΕΡΕΥΝΗΤΙΚΟ ΕΡΓΑΣΤΗΡΙΟ ΜΙΚΡΟΒΙΟΛΟΓΙΚΟ ΔΙΑΓΝΩΣΤΙΚΟ ΙΑΤΡΕΙΟ

13 Το εργαστήριο µας αποτελεί ένα διαγνωστικό εργαστήριο αναφοράς, για την πραγµατοποίηση µικροβιολογικών, βιοχηµικών, αιµατολογικών, ανοσολογικών και ορµονολογικών εξετάσεων. Στο εργαστήριο µας επίσης εκτελού νται και πιο εξειδικευµένες εξετάσεις όπως µοριακός έλεγχος µε PCR (πχ( για την µέτρηση ιικού φορτίου, έλεγχο θροµβοφιλίας κλπ), ανοσολογικός έλεγχος δυσανεξίας σε διατροφικούς παράγοντες και µέτρηση Τ Τ λεµφοκυτταρικής ανοσολογικής απάντησης. Τέλος, εκτελούνται ερευνητικά πρωτόκολλα που περιλαµβάνουν ανά λυση βιολογικών δειγµάτων, στατιστική επεξεργασία α ποτελεσµάτων και ανάπτυξη ʺin ʺ houseʺ διαγνωστικών µεθόδων, όπως ELISA µε ʺcustom ʺ peptidesʺ κλπ Επιστηµονικός υπεύθυνος του εργαστηρίου είναι ο Δρ Ιωάννης Ρούτσιας. Είναι Χηµικός και Ιατρός Βιοπαθολό γος Μικροβιολόγος µε διδακτορικό δίπλωµα στην Ανο σολογία. Το ερευνητικό του έργο είναι σηµαντικό (συνολικό Impact Factor διεθνών δηµοσιεύσεων = 242) και διεθνώς αναγνωρισµένο (H index( = 18), έτυχε δε δέκατρι ων ελληνικών και διεθνών βραβείων και διακρίσεων. Αριστούχος υπότρο φος Χηµικός, εισήχθη και φοίτησε εν συνεχεία στην Ιατρική Σχολή του Πανεπιστηµίου Ιωαννίνων ( ) 1997) όπου και εκπόνησε και την διδακτορική του διατρι βή µε υποτροφία (ΕΜΥ). Έλαβε την ειδικότητα Μικροβιολογίας στην Αθήνα (Νοσ Παίδων Π&Α Κυριακού) και υπήρξε Λέκτορας ʺΙατρικής Ανοσοχηµείαςʺ στο Χ.Π.Α. ( ), 2004), ενώ από το 2004 έως το 2011 είναι Λέκτορας Ανοσολογίας/Μικροβιολογίας στην Ιατρι κή σχολή του Πανεπιστηµίου Αθηνών. Είναι συντάκτης κριτής σε 12 διεθνή περιοδικά, έχει δηµοσιεύσει 50 άρθρα σε διεθνή περιοδικά (µεσος IF/αρθρο=4.8) µε > 900 βιβλιο γραφικές αναφορές (cita ons).( Έχει επιβλέψει 12 διατριβές, έχει διδάξει 10 διαφορετικά αντικείµενα (µαθήµατα) σε 6 τµήµατα (Ιατρική, Οδοντιατρική, Φαρµακευτική, τµήµα Διαιτολογίας, Χηµικό, ΠΣΕ Βιοχηµείας) και έχει 146 ανα κοινώσεις σε συνέδρια (Ελληνικά: 53, Διεθνή: 93). Τέλος έχει γράψει κεφάλαια σε 6 διεθνή και 7 ελληνικά βιβλία και είναι µέλος σε 6 επιστηµονικές εταιρίες και συλλό γους. ΠΑΡΑΛΑΒΗ ΑΠΟΤΕΛΕΣΜΑΤΩΝ Αποτελέσµατα εξετάσεων: Οι ιατροί έχουν την δυνατό τητα να βλέπουν τα αποτελέσµατα των δικών τους ασθενών, ανά πάσα στιγµή, από την ιστοσελίδα του ιατρείου.

14 Μικροβιολογικό Διαγνωστικό Ιατρείο Υπεύθυνος: Ιωάννης Γ. Ρούτσιας, Λέκτορας Ιατρικής Σχολής Εθνικού και Καποδιστριακού Πανεπιστηµίου Αθηνών Διεύθυνση: Δ. Σούτσου 48 & Αλεξάνδρας Αµπελόκηποι, Αθήνα έναντι του σταθµού Μετρό (στάση Αµπελόκηποι) Τηλ: Fax: E mail: jroutsias@med.uoa.gr Web: lab.gr