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DMARD’s

This drug class can slow down progression of the disease but it’s more toxic than NSAID’s.

Hydroxychloroquine (Plaquenil):  The onset of action is 3 months.  Can we wait 3 months to see if a drug is working for a RA patient?  We’d probably add another NSAID until this worked.  This was originally a drug for malaria.  Our concern for this drug is not the reversible corneal opacity (luckily the vision clears up if you stop taking it) but the problem is the irreversible retinal damage, so we have to do objective ongoing eye checkups to make sure the vision is not getting worse.

Intra-articular steroids:  When steroids are given orally, it goes through their systemic circulation, they retain fluid, gain weight and become huge.  They blow up.  An alternative to steroids are intra-articular steroids which are medicines injected directly into the joint space of a painful, inflamed arthritic joint.  They are usually long-acting steroids so it doesn’t have to happen often.  But we are limited to about 3 joints because there’s a risk of introducing the steroid into the blood stream.  Intrathecal steroid injection is associated with a high risk of infection like meningitis.  Once you introduce bacteria into a joint through a joint it’s very bad because you can’t inject an antibiotic into there.

Consequences of prolonged use of systemic steroids:

  • Adrenal suppression
  • Ulcers
  • Cataracts
  • Depression

Gold Therapy

We have two options:  An injection called gold sodium thiomalate (Myochrisine) patients have to take monthly or literally a gold tablet called auranofin (Ridaura) that must be taken daily.

Again, they may slow progression of the disease but not stop it.

Potential reactions:  Renal damage. Bone marrow depression causing a decrease in WBC and an increase in infections.  Patients must be routinely monitored once a month to make sure there’s no renal damage or bone marrow depression.

Miscellaneous DMARD’s

These have a high risk of cancer.  They may be better drugs due to their stronger capability to slow progression but the risk increases with them.

  • Anakinra (Kineret) – inj – Inhibits interleukin-1 inflammation
  • Etanercept (Enbrel) – inj – Inhibits tumor necrosis factor (TNF) inflammation
  • Leflunomide (Arava) – inj – Inhibits immune modulator inflammation

Chemotherapeutic drugs

These drugs are cancer, chemotherapy drugs but in lower doses.  Yes they can kill cancer cells, but they can also kill normal cells.  When a patient goes through cancer chemotherapy, one of the side effects is decreased immune system and higher risk of infection.  That’s the property we want with RA because RA is an auto-immune disease so we want to suppress our own immune system so we utilize low doses of cancer chemotherapy drugs.  The consequences of these drugs are that they are carcinogenic.  They can treat cancer but can also cause a cancer and infection.

Examples: azathioprine, methotrexate (Rheumatrex), cyclophosphamide

Want To Get Strong and Flexible? 💪 Check Out My Programs!

Antranik’s Rings Bodyweight Training Routine

This is for anybody who wants to get strong and have fun with a gymnastics-inspired routine. It is highly bodyweight-exercise oriented (no external weights) and … [Read More]

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I've created this hip flexibility program for those that would like to improve their flexibility in an efficient manner, with a follow along video that only … [Read More]

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I don't know about you but nothing gets me fired up more than working on my abs. It's a unique muscle group that is utilized in every exercise and making it … [Read More]

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For anyone who wants better shoulder health, shoulder flexibility, a looser upper back and improved posture, this program takes all the guess work out of it to … [Read More]

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This training routine is focused largely on increasing strength and muscle mass (aka muscular hypertrophy). If I had to sum up the routine in one fell swoop I … [Read More]

The Ultimate Flexibility Bundle

I have three premium flexibility programs that I offer and many of you have been clamoring for a bundle-package, so here it is! You could now buy the … [Read More]

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In this day and age most people are working from home and struggling to find the balance between stagnation and moving to stay fit. This program was developed … [Read More]

Antranik’s Easy Hamstrings Program

For those who have poor flexibility, tight hamstrings and want a simple program that will help them to get looser in a gentle, non-painful manner. In this … [Read More]

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