Medication Summary
The goal of therapy is to treat the clinical syndrome resulting from the effects of soluble circulating immune complexes that form under conditions of antigen excess. These immune complexes can originate from the administration of either heterologous antisera or drugs known to cause serum sickness.
Nonsteroidal anti-inflammatory drugs
Class Summary
These agents have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not known, but they may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms may also exist, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell-membrane functions.
Ibuprofen (Motrin, Ibuprin, Advil, Caldolor, Addaprin, Ultraprin)
Ibuprofen decreases inflammation by blocking prostaglandin synthesis and reduces fever by acting on the hypothalamic temperature-regulating center. It is usually administered for mild symptoms of arthralgia, myalgia, or fever.
Naproxen (Anaprox, Aleve, Naprosyn, Naprelan)
Naproxen is indicated for relief of mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing activity of cyclooxygenase, which results in a decrease of prostaglandin synthesis.
Ketoprofen
Ketoprofen is used for relief of mild to moderate pain and inflammation. Small dosages are initially indicated in small and elderly patients and in those with renal or liver disease. Doses of more than 75 mg do not increase therapeutic effects. Administer high doses with caution and closely observe patient for response.
Antihistamines
Class Summary
Antihistamines act by competitive inhibition of histamine at the H1 receptor. This mediates the wheal and flare reactions, bronchial constriction, mucous secretion, smooth muscle contraction, edema, hypotension, CNS depression, and cardiac arrhythmias.
Diphenhydramine HCL (Benadryl, Aler-Cap, Aler-Dryl, Anti-Hist)
Diphenhydramine blocks histamine H1 receptors on the target tissue. It used for urticarial rash.
Corticosteroids
Class Summary
These agents have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.
Prednisone
Prednisone acts by altering the number and availability of leukocytes, reducing vascular permeability, and suppressing cytokines. This agent is the mainstay of treatment in severe cases; it is usually administered in moderate doses for 1-2 weeks. Prednisone, or other oral corticosteroids (eg, prednisolone), is useful in managing mild-to-moderate serum sickness treated in an outpatient setting.
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A 29-year-old woman with RA presented with fever, a diffuse skin rash, and arthralgia approximately 10 days after receiving intravenous rituximab. Diagnosis was rituximab-associated serum sickness. Image courtesy of Jason Kolfenbach, MD, and Kevin Deane, MD, Division of Rheumatology, University of Colorado Denver School of Medicine.
