Page 680 - Basic _ Clinical Pharmacology ( PDFDrive )

666 SECTION VI Drugs Used to Treat Diseases of the Blood, Inflammation, & Gout

Westhovens R et al: Clinical efficacy and safety of abatacept in methotrexate-naïve Drugs Used in Gout
patients with early rheumatoid arthritis and poor prognostic factors. Ann
Rheum Dis 2009;68:1870. Becker MA et al: Febuxostat compared with allopurinol in patients with hyperuri-
Westhovens R et al: Disease remission is achieved within two years in over half cemia and gout. N Engl J Med 2005;353:2450.
of methotrexate naive patients with early erosive rheumatoid arthritis (RA) Getting SJ et al: Activation of melanocortin type 3 receptor as a molecular mecha-
treated with abatacept plus MTX: results from the AGREE trial (abstract nism for adrenocorticotropic hormone efficacy in gouty arthritis. Arthritis
638). Arthritis Rheum 2009;60:S239. Rheum 2002;46:2765.
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with systemic juvenile idiopathic arthritis. Expert Rev Clin Immunol for the management of hyperuricaemia in patients with gout. Expert Opin
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Zouali M, Uy EA: Belimumab therapy in systemic lupus erythematosus. BioDrugs So A et al: A pilot study of IL-1 inhibition by anakinra in acute gout. Arthritis
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U.S. Food and Drug Administration: Questions and Answers About FDA’s
Enforcement Action Against Unapproved Injectable Colchicine Products.
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C ASE STUD Y ANSWER

This patient had good control of his symptoms for 1 year adding sulfasalazine and hydroxychloroquine) or adding
but now has a prolonged flare, probably denoting worsen- a biologic medication, usually a TNF inhibitor. Follow-
ing disease (not just a temporary flare). In addition to up should be every 1–3 months to gauge response and
physical findings and measurement of acute-phase reac- toxicity. Adverse events requiring caution are an increased
tants such as sedimentation rate or C-reactive protein, it risk of infection, possible appearance of lymphoma and
would be wise to get hand and feet radiographs to docu- rare liver function test or hematologic abnormalities.
ment whether he has developed joint damage. Assuming Importantly, close follow-up should ensue, including
such damage is found, the appropriate approach would changing medications every 3–6 months until full disease
be either a combination of nonbiologic DMARDs (eg, control is achieved.