Pediatric emergency medicine trisk 2989 2989
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (101.19 KB, 1 trang )
TABLE 101.13
DMARDs USED IN THE TREATMENT OF JIA
Drug
Dosing schedule
Side effects
Methotrexate
Weekly
Nausea, hair loss, chemical
hepatitis, hypersensitivity,
pneumonitis
Leflunomide
Once a day
Nausea, diarrhea, chemical
hepatitis
Sulfasalazine
Twice a day
Gastric irritation,
photosensitivity, behavioral
changes, hypersensitivity
reaction, neutropenia
Abdominal pain, diarrhea,
retinitis
Hydroxychloroquine Once a day
DMARDs, disease-modifying antirheumatic drugs; JIA, juvenile rheumatoid arthritis.
Corticosteroids must be employed judiciously in JIA due to the significant toxicity
associated with their use. Systemic steroids are typically reserved for children with
severe complications or time-limited flares, for example, in the setting of systemic
symptoms, pericarditis, or pleuritis, during brief flare-ups of severe arthritis, or while
waiting for slower-acting agents to take effect. Intra-articular steroids may be used in
patients with oligoarthritis, or in children with polyarticular disease in whom selected
joints require particularly aggressive management. Topical ophthalmologic steroids are
the mainstay of therapy for iridocyclitis, though their use is limited by local toxicity,
oftentimes necessitating the use of systemic immune modulatory therapy to treat eye
inflammation even in the absence of joint inflammation.
Drug Toxicity. Almost all drugs used for the treatment of JIA have the potential for
serious toxicity. If a child with JIA on treatment develops a new symptom, drug
toxicity must always be considered as a possible cause. Tables 101.12 and 101.13 list
the common adverse reactions reported with NSAIDs and DMARDs typically used in
the treatment of JIA. Though new medications are more targeted in their effects on the
immune system, most advanced therapies for arthritis cause at least some
immunosuppression. Accordingly, physicians caring for children with JIA should be
particularly vigilant for evidence of infections.
For the nonsteroidal anti-inflammatory agents, GI toxicity is the most common side
effect. Nonetheless, significant NSAID gastropathy is unusual in children, and gastric
or intestinal perforations, a significant problem in older adults, are rare. NSAIDs may
also cause various other side effects. Reversible CNS complaints, particularly
