SECOND LINE DRUGS-Contd.
Corticosteroids
Corticosteroids are mostly glucocorticoids used as anti-inflammatory drugs. They are cortisol analogs.
In severe progressive RA prednisone can give some benefits. Because of the seriousness of side effects corticosteroids are considered to be the drugs of last choices.
They are used in,
1.Acute flare-ups of the disease
2.As adjuncts with other slow-acting drugs
3.In elderly patients as alternatives for more toxic second-line drugs
4.In patients who cannot tolerate or who are allergic to NSAIDs.
5.In patients with a systemic attack of RA.
Administration and Dosage
Oral prednisone is 5 to 10mg may be enough to some patients
Because of the serious adverse effects dosage should be limited to possible low with care.
If pain is localized to one or few inflamed joints an intraarticular injection may be beneficial.
Side Effects
1. Immunosuppression leads to delay in wound healing
2.G.I.Bleeding
3.Myopathy
4.Cataracts
5.Hyperglycemia
6.Hypertension
7.Osteoporosis
Topical Treatments
Topical treatments are safer but less systemic. They are counter irritants and rubefacients.
Capsaicin which is a pungent hot ingredient of pepper can be used as a rubefacient to relieve RA.
Capsaicin is blocking the substance-P which transmits the pain impulses from the periphery to the brain through sensory nerves.
Capsaicin can be applied three or four times a day to get good relief.
It is available in the market by the brand Zostrix
Counter Irritants
1.Allyl isothiocyanate
2.Methylsalicylate
3.Menthol
All the above drugs produce mild counter inflammations and thereby relieve the RA pain.
They should be applied to the skin followed by gentle massages.
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