45. It is good to feel better
but
it is better to feel good
病情進步, 感覺真好
治療達標, 絕對更好
Editor's Notes
DM
HT
Hyperlipidemia—lowest risk is associated with the lowest LDL level
Comprehensive evidence base
people with RA have higher rates of absenteeism, early retirement, reduced work performance (known as presenteeism), and difficulty remaining employed.2 Approximately 70% of patients develop irreversible joint destruction within the first year after their diagnosis, with about 80% suffering pain, stiffness, and functional disability.5
Global prevalence 0.24%
DALY : 4.8 Million
Gold : inhibits release of prostaglandin from synovial cell slow down bond and cartilage destruction. Side eff: dermatitis , diarrhea, metalic taste of mouth , pigmentation
Jaundice, peripheral neuropathy, aplastic anemia
MTX:胸腺嘧啶核甘酸合成酶抑制劑 inhibits synthesis of thymidylate synthetase by inhibiting folic acid utilization thus decrease maturization of immunologic cells
Side eff : GI upset, oral ulcer, pancytopenia, abnormal LFT, pneumonia –like synd
Azathioprine : suppress B and T cell function
Sulfasalazine
Hydroxychloroquine: decrease leukocyte chemotaxis, stablize lysosomal membrane, trap free radical
D-penicillamine—metabolite of PCN, a chelating agent, interfer synthesis of DNA , collagen and polysacharide
side eff: skin rash, leukopenia, anemia, thrombocytopenia, nasua , vomiting, proteinuria
Cyclophsophamide: inhibit cell proliferation by cross-linking with DNA
Clyclosporine A : supress IL-2 and TNF a
Leflunomide : inhibit T cell proliferation and production of autoantibodies by B cell
Algorithm based on the 2013 European League Against Rheumatism recommendations on rheumatoid arthritis management. ACPA, anti-citrullinated protein antibody; DMARD, disease-modifying antirheumatic drug; RF, rheumatoid factor; TNF, tumour necrosis factor.
Contra : hepatic or renal Dx, lung disease,
1-week exposure to
high-dose GCs did not deteriorate the metabolic state in active
RA.130 Chronic treatment with 10 mg prednisone daily did not
lead to higher glucose levels or increased incidence of diabetes.7
However, worsening of pre-existent diabetes has been described
in RA,131 and an incidence of 12.6% of GC-induced diabetes
has been found among lupus patients after a mean of 34 days
after starting high-dose GC therapy
Recent Hx of lymphoma or any malignancy , latent TB with contra to use chemoprophylaxis, living in a TB endemic reigon,Hx of demyeling disease
The least expensive
