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Arthritis Information and Help Is Only a Click AwayKeeping up to date with the latest arthritis information is vital for anyone that lives daily with the pain and suffering arthritis can cause. Research continues to make progress mainly in finding the basic causes for the key types of arthritis,...
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An Arthritis Treatment using Massage There are many different ways to get an arthritis treatment. Massage therapy is one of the best ways to ease the pain of arthritis. This type of arthritis treatment deals with the stiffness that is associated...
Rheumatoid Arthritis Diagnosis
Rheumatoid arthritis, or RA, is known to cause the inflammation of joints, and its damage gradually reduces body movement. The symptoms can be observed as stiff joints in the morning hours; as one ages, RA can affect other organs of the body such...
Remicade: Doctor, I Have Rheumatoid Arthritis and I Want to Know More About Remicade
TNF alpha is a protein that is produced during the inflammatory response. It both starts as well as perpetuates inflammation. Increased levels of TNF are found in several inflammatory conditions including rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. Drugs that block tumor necrosis factor (TNF) have been found to be particularly effective for the treatment of these serious types of inflammatory arthritis.
Infliximab (Remicade) is a monoclonal chimeric antibody (part human, part mouse) directed against TNF alpha.
Infliximab is approved for use alone or combined with methotrexate for treating moderate to severe rheumatoid arthritis. It also is approved for the treatment of active psoriatic arthritis and ankylosing spondylitis.
Infliximab is administered intravenously. The recommended dose for the treatment of rheumatoid arthritis is 3 mg/kg as a single dose. The initial dose should be followed by additional 3 mg/kg doses two and six weeks after the first dose. The maintenance dose depends on the patient’s response. It can be increased to a maximum of 10 mg/kg every 4 weeks.
The most common side effects of infliximab are upper respiratory tract infections, urinary tract infections, cough, rash, back pain, nausea, vomiting, abdominal pain, headache, weakness and fever. Infusion reactions, which are sometimes severe, may occur.
Side effects such as blood pressure changes, chest pain, shortness of breath, rash, itching, fever and chills may occur during or shortly after administration. These reactions could possibly be due to an allergy to the drug. They are more common among patients who develop antibodies to infliximab and are less likely to occur in patients who are taking drugs that suppress the immune system, such as methotrexate. Infliximab should be discontinued if serious reactions occur.
Serious infections have been reported with other drugs that block TNF- alpha, and infections have been reported during treatment with infliximab. Therefore, infliximab should not be used in patients with serious
infections. Infliximab should be discontinued if a serious infection develops during treatment.
Before starting infliximab, persons should have tuberculosis skin testing, because of reports of reactivation of tuberculosis in patients taking infliximab.
There have been rare cases of serious liver injury in people taking infliximab. Screening for hepatitis B may be a good idea.
Infliximab should not be used in patients with congestive heart failure or other significant heart disease.
Approximately half of infliximab-treated patients in clinical trials developed a positive ANA during the trial compared with approximately one-fifth of placebo-treated patients. Anti-dsDNA antibodies were newly detected in approximately one-fifth of infliximab-treated patients compared with 0% of placebo-treated patients. Reports of lupus and lupus-like syndromes, however, remain uncommon.
Decreased white and red blood cell and decreased platelet counts have been reported with infliximab. Vasculitis (inflammation of arteries) also has been reported.
Patients with rheumatoid arthritis, particularly patients with very active disease and/or chronic exposure to immunosuppressive therapies, may be at a higher risk (up to several fold) than the general population for the development of lymphoma. It is not known whether anti-TNF therapy raises this level of risk.
Infliximab should not be used in combination with anakinra (Kineret).
Dr. Wei (pronounced “way”) is a board-certified rheumatologist and Clinical Director of the nationally respected Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine and has served as a consultant to the Arthritis Branch of the National Institutes of Health. He is a Fellow of the American College of Rheumatology and the American College of Physicians. For more information on arthritis and related conditions, go to: http://www.arthritis-treatment-and-relief.com
Written By: Nathan Wei
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