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aggressive treatment to preserve joint function.
3. Medication therapy includes NSAIDs, glucocorticoids,
and disease-modifying antirheumatic drugs
(DMARDs).
4. Gold salts: Use of gold salts has decreased, but their
purpose is to reduce the progression of joint damage
caused by arthritic processes. Gold toxicity,
characterized by pruritus, rash, metallic taste,
stomatitis, and diarrhea, can occur; if toxicity occurs,
dimercaprol may be prescribed to enhance gold
excretion.
B. DMARDs
1. Description
a. DMARDs are effective antirheumatic
medications that are used to slow the
degenerative effects of the disorder.
b. DMARDs are usually prescribed
secondary to NSAIDs but are often the
first choice in the treatment of severe
arthritis.
2. Common side and adverse effects of DMARDs

include injection site inflammation and pain,
ecchymosis, and edema; pancytopenia and infection;
fatigue, headache, nausea, vomiting, and flu-like
symptoms; and allergic response.

3. Interventions

a. Instruct the client to monitor for signs
of infection and report signs to the
PHCP.
b. Monitor the injection site for signs of
irritation, pain, inflammation, and
swelling.
c. Instruct the client to consult with the
PHCP before receiving live vaccines
and to avoid exposure to infections.
d. Inform the client about the importance
of laboratory tests for neutrophil
counts, white blood cell counts, and
platelet counts before initiation of
treatment and during treatment.
4. Anakinra: Injection site reactions are common
(pruritus, erythema, rash, pain).
5. Adalimumab
a. Injection site reactions are common.
b. Has been associated with neurological

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