Viral Arthritis Medication

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

Class Summary

The agents have analgesic, anti-inflammatory, and antipyretic activities. Their mechanisms of action are unknown, but they may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms may be present, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions.

Naproxen (Anaprox, Naprelan, Aleve, Naprosyn)

Used for relief of mild to moderate pain; inhibits inflammatory reactions and pain by decreasing activity of cyclooxygenase, which is responsible for prostaglandin synthesis

Class Summary

These derivatives of 4-aminoquinoline are active against various autoimmune disorders.

Hydroxychloroquine (Plaquenil)

Inhibits chemotaxis of eosinophils and locomotion of neutrophils and impairs complement-dependent antigen-antibody reactions. Hydroxychloroquine sulfate 200 mg is equivalent to 155 mg hydroxychloroquine base and 250 mg chloroquine phosphate.

Class Summary

These agents are used to improve clinical and immunologic aspects of the disease. They may decrease autoantibody production and increase solubilization and removal of immune complexes.

Immune globulin, intravenous (Gammar-P, Sandoglobulin, Gammagard)

Neutralizes circulating myelin antibodies through antiidiotypic antibodies; down-regulates proinflammatory cytokines, including INF-gamma; blocks Fc receptors on macrophages; suppresses inducer T and B cells and augments suppressor T cells; blocks complement cascade; promotes remyelination; may increase CSF IgG (10%).

Class Summary

These are naturally produced proteins with antiviral, antitumoral, and immunomodulatory actions. Alfa-, beta-, and gamma-interferons may be given topically, systemically, and intralesionally.

Interferon alfa-2b (Intron A)

Protein product manufactured by recombinant DNA technology. Mechanism of antitumor activity is not clearly understood; however, direct antiproliferative effects against malignant cells and modulation of host immune response may play important roles.

Class Summary

These agents have anti-inflammatory properties and cause profound and varied metabolic effects. They modify the body's immune response to diverse stimuli.

Prednisone (Meticorten, Sterapred, Deltasone)

Immunosuppressant for treatment of autoimmune disorders; may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Stabilizes lysosomal membranes and suppresses lymphocyte and antibody production.

Class Summary

These agents inhibit key factors responsible for deregulated cell proliferation.

Cyclophosphamide (Neosar, Cytoxan)

Alkylating agent that depresses T- and B-cell function.

Methotrexate (Folex PFS, Rheumatrex)

Unknown mechanism of action in treatment of inflammatory reactions; may affect immune function. Ameliorates symptoms of inflammation (eg, pain, swelling, stiffness). Adjust dose gradually to attain satisfactory response.

Class Summary

These agents inhibit key factors responsible for inflammation.

Sulfasalazine (Azulfidine, EN-tabs)

Useful in the management of ulcerative colitis and acts locally in colon to decrease the inflammatory response. Systemically inhibits prostaglandin synthesis.

Class Summary

Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients who experience pain.

Acetaminophen (Aspirin-Free Anacin, FeverAll, Tempra, Tylenol)

DOC for pain in patients with documented hypersensitivity to aspirin or NSAIDs, with upper GI disease, or who are taking oral anticoagulants.

Class Summary

Nucleoside analogs are initially phosphorylated by viral thymidine kinase to eventually form a nucleoside triphosphate. These molecules inhibit HSV polymerase with 30-50 times the potency of human alpha-DNA polymerase.

Ribavirin (Rebetol, Virazole, Rebetron)

Indicated for chronic HCV infection. Inhibits replication of RNA and DNA viruses. Additionally, inhibits initiation and elongation of RNA fragments, resulting in inhibition of viral protein synthesis.

Class Summary

Therapy must cover all likely pathogens in the context of this clinical setting. Indications include Pneumocystis carinii pneumonia and HCV infection.

Pentamidine (Pentacarinat, Pentam-300, NebuPent)

Inhibits growth of protozoa by blocking oxidative phosphorylation and inhibiting incorporation of nucleic acids into RNA and DNA, causing inhibition of protein and phospholipid synthesis.

Sulfamethoxazole and trimethoprim (Septra, Cotrim, Bactrim)

Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid. Antibacterial activity of TMP-SMZ includes common urinary tract pathogens, except Pseudomonas aeruginosa.