Medication Summary
The goals of pharmacotherapy are to reduce morbidity and to prevent complications.
Gold compounds
Class Summary
These agents inhibit immune reactions.
Aurothioglucose (Solganal)
Disease-modifying antirheumatic drug (DMARD). Less experience with the PO preparation (Auranofin) for Felty syndrome.
Immunosuppressive agents
Class Summary
These agents inhibit key factors in the immune system responsible for immune reactions.
Methotrexate (Rheumatrex)
Antineoplastic agent that is immunosuppressive at lower doses. Very effective in treating RA. Antirheumatic effects may take several weeks to become apparent. Unknown mechanism of action in treatment of inflammatory disorders; may affect immune function. Ameliorates symptoms of inflammation (eg, pain, swelling, stiffness). Succinct guidelines for use and monitoring are available from the American College of Rheumatology.
Cyclophosphamide (Cytoxan)
Antineoplastic alkylating agent and immunosuppressive agent. Reduces the number of B and T cells. Increases risk for infection.
Colony-stimulating factors
Class Summary
These agents stimulate production, maturation, and activation of neutrophils and increase migration and cytotoxicity of neutrophils.
Filgrastim (Neupogen)
A solid record of success is emerging with the use of these agents in patients with Felty syndrome and infections that are not responding to antibiotics alone. Most experience has been with the use of G-CSF.
Sargramostim (Leukine)
GM-CSF stimulates division and maturation of earlier myeloid and macrophage precursor cells. Reportedly increases granulocytes in 48-91% of patients.
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