Adverse Drug Reactions in Rheumatoid Arthritis Patients Taking Combination DMARDs

Singh, Priya; Bharat, Suyash; Bano, Mehar; Gaur, Sanjay; Srivastava, Bhavana

doi:10.18535/jmscr/v4i8.73

Cited by 3 publications

(14 citation statements)

References 17 publications

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“…Blurred vision occurs in up to 3% of patients due to corneal deposits and may be reversible and the retinal deposition of hydroxychloroquine is a concern because this is more common in older patients on longer-term treatment and is irreversible and may worsen with time. 4 In the present study, 5 patients developed hyperpigmentation of the skin but in study conducted by Singh P et al, showed that 7 patients developed hyperpigmentation. Hydroxychloroquine induced pigmentation is not a rare adverse effect.…”

Section: Discussioncontrasting

confidence: 53%

“…The ADRs of hydroxychloroquine were nausea, stomach pain, stomach cramps, diarrhoea, blurred vision, hyperpigmentation. 4 In the present study 7 patients developed blurring of vision but in study conducted by Singh P et al, showed 2 patients with blurring of vision. Blurred vision occurs in up to 3% of patients due to corneal deposits and may be reversible and the retinal deposition of hydroxychloroquine is a concern because this is more common in older patients on longer-term treatment and is irreversible and may worsen with time.…”

Section: Discussioncontrasting

confidence: 48%

“…Methotrexate is active in management of RA at lower doses than those needed in cancer chemotherapy. 4 Methotrexate is considered to be the most tolerable in long term therapies. 16 However chronic use of steroids, NSAIDs and DMARDs, both biological and non biologicals, used for the management of RA can increase the type and frequency of adverse reactions.…”

Section: Discussionmentioning

confidence: 99%

“…1,9 The most common toxicity due to disease modifying anti rheumatic drug, methotrexate are nausea and mucosal ulcers and the frequently occurring hepatotoxicity is in the form of hepatic enzyme elevation. 4 Approximately 30% of the patients using sulfasalazine discontinue the drugs because of toxicity. The dosage of hydroxychloroquine greater than 6.4mg/kg/day are prone for ocular toxicity than at lower dose.…”

mentioning

confidence: 99%

“…However, it is advisable to do ophthalmologic monitoring every 6 to 12months. 4 Drugs used in the treatment of rheumatoid arthritis show significant toxicity and leading cause for morbidity, therefore monitoring for adverse reaction is necessary for early detection of toxicity and should be documented and the patient should be informed as well. 10 Hence the present study of active surveillance of adverse drug reactions (ADRs) in patients with RA on anti-rheumatic drugs is done for the early detection of adverse drug reaction, for their management and reduction of morbidity.…”

mentioning

confidence: 99%

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Active surveillance of adverse drug reactions in patients with rheumatoid arthritis in a tertiary care teaching hospital

Ramarao

Mai

Meenakshi

et al. 2018

Int J Basic Clin Pharmacol

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Background: Drugs used in the treatment of rheumatoid arthritis show significant toxicity and morbidity. The objective of the study was to evaluate the nature and incidence of adverse drug reaction in patients with rheumatoid arthritis on anti-rheumatic drugs and to assess the causality and severity of the documented adverse drug reactions.Methods: The prospective observational study was done for two months in rheumatology outpatient department. All patients were interviewed for basic details, treatment history and adverse drug reactions and were recorded. Causality assessment and severity assessment of the recorded adverse drug reactions were done.Results: About 283 patients attended the rheumatology out-patient department during the two months period out of which 57 patients had one or more adverse drug reaction. The incidence of adverse drug reaction observed in rheumatology out-patient department to anti rheumatic drug was 20.14%. A total of 145 adverse drug reactions were noted in 57 patients. The most common adverse drug reaction reported was epigastric pain (6.89%) followed by headache and dyslipidemia (6.25%). The most common system associated with adverse drug reaction was gastrointestinal system (29.66%) followed by central nervous system and cardiovascular system (15.86%). Reported adverse drug reactions were assessed for causality and maximum belonged to probable (66.9%). Severity assessment revealed that most of the adverse drug reactions were mild (74.48%) in nature.Conclusions: Active surveillance for adverse drug reactions to anti rheumatic drug in patients with rheumatoid arthritis will allow early detection of adverse drug reactions and timely intervention to provide maximum benefit to the patients.

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Section: Discussioncontrasting

confidence: 53%

Section: Discussioncontrasting

confidence: 48%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Active surveillance of adverse drug reactions in patients with rheumatoid arthritis in a tertiary care teaching hospital

Ramarao

Mai

Meenakshi

et al. 2018

Int J Basic Clin Pharmacol

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Assessment of adverse drug reaction profile of the disease-modifying anti-rheumatic drugs at the department of orthopaedics in a tertiary care hospital, Silchar, Assam, India

Kairi

Chakravarty

Sipani

2019

Int J Basic Clin Pharmacol

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Background: The mainstay of treatment of Rheumatoid Arthritis (RA) is the use of the disease-modifying anti-rheumatic drugs (DMARDs). Methotrexate, sulfasalazine and hydroxychloroquine are some of the DMARDs which are used in combination for the treatment of RA. The current study was undertaken to assess the adverse drug reactions (ADRs) of DMARDs that are commonly encountered with the treatment of RA.Methods: The present study was designed as a prospective, observational study on newly diagnosed patients with RA. Patients diagnosed with RA above 18 years (excluding pregnant women) of either sex who were prescribed DMARDs in combination were included. ADRs reported spontaneously by the patients and also responses obtained in a questionnaire related to likely ADRs from the patients was recorded in the case record form. Statistical analysis was done using graph pad and p value <0.05 was considered to be statistically significant.Results: A total of 47 patients attending the Outpatient Department of Orthopaedics, Silchar Medical College and Hospital, Silchar, Assam, India were screened for the study. ADRs were monitored up to the last visit on 41 patients excluding the patients who were lost and who were not able to adhere to the treatment. A total of 27 ADRs were reported from 19 ADR forms. Gastrointestinal manifestations were the most common adverse effects of combination DMARDs seen in 10 patients (24.39%). Severity assessment done using modified Hartwig and Siegel scale that showed majority of the ADRs were mild (74.07%).Conclusions: Present study showed that DMARDs are well-tolerated and have an acceptable toxicity profile as majority of ADRs seen were mild. It was however difficult to prevent the occurrence of ADRs. Proper monitoring of therapy is needed for early recognition of ADRs.

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Evaluation of prescription practices in rheumatoid arthritis at the rheumatology clinic in a tertiary care teaching hospital in Uttarakhand

Mittal

Bisht

Pai

et al. 2021

Journal of Family Medicine and Primary Care

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Objective: This study was aimed to analyze the prescription pattern of disease modifying anti-rheumatic drug (DMARD) therapy in patients with rheumatoid arthritis (RA) in a tertiary care teaching hospital in Uttarakhand, India. Methodology: This cross-sectional study was conducted in 150 RA patients who were given DMARD therapy. Patient's demographic details, drugs prescribed with their dosage and administration routes and the usage of complementary and alternative medicine (CAM) therapy were recorded to study the prescription pattern. Results: Overall, 4 DMARDs were prescribed in all the studied patients: Methotrexate ( n = 150), hydroxychloroquine ( n = 35), leflunomide ( n = 5), and adalimumab ( n = 1). Single DMARD therapy with methotrexate was prescribed to 110 (73.3%) followed by double therapy with methotrexate + hydroxychloroquine in 35 (23.3%), triple therapy (methotrexate + hydroxychloroquine + leflunomide) in 4 (2.7%) and triple therapy with biological DMARD (methotrexate + hydroxychloroquine + leflunomide + adalimumab) in 1 (0.7%) patient. Adjuvant therapy drugs included: Prednisolone ( n = 150), folic acid ( n = 150), naproxen ( n = 150), calcium ( n = 150), vitamin D ( n = 150) and indomethacin ( n = 40). Of the total, 61.4% patients also took complimentary alternative medicine (CAM) therapy. Conclusion: Our study concludes that the most commonly prescribed DMARDs in our setting, to patients of RA, in descending order of frequency were methotrexate, followed by hydroxychloroquine, leflunomide and lastly adalimumab. A total of five adjuvant medications were commonly prescribed to all patients. There was a high prevalence of self-medicated CAM therapy in the majority of these patients.

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Adverse Drug Reactions in Rheumatoid Arthritis Patients Taking Combination DMARDs

Cited by 3 publications

References 17 publications

Active surveillance of adverse drug reactions in patients with rheumatoid arthritis in a tertiary care teaching hospital

Active surveillance of adverse drug reactions in patients with rheumatoid arthritis in a tertiary care teaching hospital

Assessment of adverse drug reaction profile of the disease-modifying anti-rheumatic drugs at the department of orthopaedics in a tertiary care hospital, Silchar, Assam, India

Evaluation of prescription practices in rheumatoid arthritis at the rheumatology clinic in a tertiary care teaching hospital in Uttarakhand

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