C H A P T E R 1 6
Anti-inflammatory, antiarthritis and related agents
255
Because leflunomide can cause severe liver dysfunc-
tion if it is combined with other hepatotoxic drugs, this
combination should be avoided.
The absorption of penicillamine is decreased if it is
taken with iron salts or antacids; if these are both being
given, they should be separated by at least 2 hours.
Anakinra and etanercept should not be used together
because of an increased risk of serious infections.
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Chronic or excessive activity by the inflammatory
response can lead to the release of lysosomal enzymes
and tissue destruction.
■■
Anti-inflammatory drugs block various chemicals
associated with the inflammatory reaction. Anti-
inflammatory drugs may also have antipyretic (fever-
blocking) and analgesic (pain-blocking) activities.
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Salicylates block prostaglandin activity. NSAIDs
block prostaglandin synthesis. Paracetamol causes
vasodilation and heat release, lowering fever
and working to relieve pain. Gold salts prevent
macrophage phagocytosis, lysosomal release
and tissue damage. DMARDs alter the course of
the inflammatory process and treat arthritis by
aggressively affecting the process of inflammation.
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Salicylates can cause acidosis and eighth cranial
nerve damage. NSAIDs are mostly associated with
GI irritation and bleeding. Paracetamol can cause
serious liver toxicity. The gold salts cause many
systemic inflammatory reactions. Other antiarthritis
drugs are associated with local injection-site irritation
and increased susceptibility to infection; leflunomide
is associated with severe hepatic toxicity.
■■
Many anti-inflammatory drugs are available OTC,
and care must be taken to prevent abuse or overuse of
these drugs.
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ONLINE RESOURCES
An extensive range of additional resources to enhance teaching
and learning and to facilitate understanding of this chapter may
be found online at the text’s accompanying website, located on
thePoint at
These include Watch and
Learn videos, Concepts in Action animations, journal articles,
review questions, case studies, discussion topics and quizzes.
WEB LINKS
Healthcare providers and students may want to consult
the following Internet sources:
Home page of Arthritis Australia. Information about
arthritis and support services.
Home page of Arthritis New Zealand. Information
about arthritis and support services.
Care considerations for
people receiving antiarthritis agents
Care considerations for people receiving the drugs
listed in this section are similar to those for people
receiving NSAIDs and related agents. Details related
to each individual drug can be found in the specific
drug monograph in your drug guide.
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Gold salts prevent macrophage phagocytosis,
lysosomal release and tissue damage because the gold
salts are taken up by phagocytes, which then are not
able to function in a normal way.
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Gold salts are deposited in the tissues and cause an
assortment of inflammatory reactions, including
stomatitis, glossitis, gingivitis, pharyngitis, laryngitis,
colitis, diarrhoea and other GI inflammation; gold
bronchitis and interstitial pneumonitis; bone marrow
depression; vaginitis and nephrotic syndrome;
dermatitis, pruritus and exfoliative dermatitis; and
allergic reactions ranging from flushing, fainting and
dizziness to anaphylactic shock.
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Drugs used to alter the inflammatory process
involved in arthritis are called disease-modifying
antirheumatic drugs (DMARDs) and can be
associated with serious to potentially fatal infections.
If used early in the disease, they can prevent or slow
down the damage caused to the joints.
■■
The DMARDs can cause local irritation at the
injection site, liver impairment and a variety of CNS
problems, including demyelinating disorders.
CHAPTER SUMMARY
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The inflammatory response, which is important
for protecting the body from injury and invasion,
produces many of the signs and symptoms associated
with disease, including fever, aches and pains and
lethargy.
KEY POINTS
