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Theo dõi
To monitor for drug
toxicity, complete blood count, serum creatinine, liver function tests,
hepatitis B and C screening, ophthalmologic exam, latent TB screening (for
bDMARDs, with chest X-ray) are requested. It is recommended to monitor patients
for drug toxicity due to the potential risks of serious adverse effects prior
to resuming or increasing therapy with DMARDs.
Prior to tapering of
therapy, patients should have a low disease activity or be in remission for at
least 6 months. A dose reduction (decrease in dose or increase in the dosing
interval) is recommended over gradual discontinuation of a DMARD along with a
close evaluation of patients during any tapering of therapy. Patients in
persistent remission can consider tapering bDMARD or tsDMARD therapy after
tapering glucocorticoid therapy. Tapering of csDMARD treatment may also be
considered.
Flare risk is inversely
proportional to disease activity and sustained response duration, thus, to
decrease the risk of flares, gradual withdrawal of biological therapies should
be done. As discontinuation of therapy is associated with a high risk of
flares, careful reduction of dose or increase in the interval can be done with all
bDMARDs and tsDMARDs with a little risk of flares. Most patients who flare can
regain their prior good response upon prompt re-institution of the same bDMARD
or tsDMARD therapy. Ceasing treatment with csDMARDs is associated with increased
flare frequency, hence tapering should be done cautiously and should be
evaluated rigorously.
- Moderate-high disease activity: Monthly
- Sustained low disease activity or remission: Every 6 months
Tiên lượng
Poor prognostic factors in patients with rheumatoid arthritis include a high count of swollen joints, evidence of early erosions, the presence of rheumatoid factor and/or anti-citrullinated protein antibody (particularly at high levels), high levels of acute phase reactants, moderate or high disease activity persisting despite treatment with csDMARDs based on composite measures including joint count, treatment failure with ≥2 csDMARDs, and other factors such as female gender, older age, smoking history, and presence of obesity or anemia.