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Maintain on a DMARD as long as joint inflammation persists Use sequential DMARDs if adverse effects Use combination therapy of DMARDs if a single agent gives only partial control Withdraw NSAIDs or change to p.r.n. use if possible Use corticosteroid intra-articular therapy or pulse therapy for disease flares Fig. 15.3 Flow diagram for the drug treatment of rheumatoid arthritis. within the joint synovium. DMARDs are used principally for rheumatoid arthritis and in peripheral joint disease...

Drug treatment of arthritis

The patient's priority is relief of joint pain, swelling and stiffness. In addition to providing symptomatic relief, the doctor must avoid the long-term effects of inadequately treated joint inflammation, which leads to joint failure requiring multiple orthopaedic operations. There is no cure for arthritis (except septic arthritis), and the available drugs are sometimes poorly tolerated. Many patients with arthritis turn to complementary therapies which may interact with conventional drugs....

Glutathione And Alkalosis Spondylosis

Vomiting, dizziness and ataxia occur. Allergic reactions occur and there is cross-reactivity with aspirin. Indomethacin may aggravate pre-existing renal disease. Drugs of this group are best avoided where there is gastroduodenal, renal or central nervous system disease or in the presence of infection. Unusually among the NSAIDs, adverse effects of sulindac on the kidney may be less likely as the active (sulphide) metabolite of sulindac appears not to inhibit renal...

Disorders Of Neuromuscular Transmission

In myasthenia gravis synaptic transmission at the neuromuscular junction is impaired most cases have an autoimmune basis and some 85 of patients have a raised titre of autoantibodies to the muscle acetylcholine receptor. The condition is probably heterogeneous, however, as about 15 do not have receptor antibodies, or have antibodies to another neuromuscular junction protein (muscle specific kinase) and rarely it occurs with penicillamine used for rheumatoid arthritis. Neostigmine was introduced...