Similar to infliximab
Baseline CBC, LFT, hepatitis B, PPD; CBC, LFTs every 3—6 mos
Abbreviations'. CBC, complete blood count; GI, gastrointestinal; IM, intramuscularly; IV, intravenously; LFT, liver function test; PO, by mouth; PPD, purified protein derivative; q, every; SLE, systemic lupus erythematosus; SQ, subcutaneously; TB, tuberculosis. Source: Adapted from Gardner, 2010.
2009). Additional supplements, such as calcium 1,000-1,500 mg/ day and 400 units of vitamin D, should be given to patients on daily steroids to decrease inflammatory effect (Gardner, 2010).
Thie inflammation, pain, and activity limitations of RA can be devastating to patients. Because some of the patients are younger, their ability to work can be adversely affected. Compliance with the medication regimen is extremely important for the patient, and the health care provider will need to assess the patient routinely for compliance and any adverse effects that are limiting full compliance with the medications.
Because the patient with RA may be anemic, anorexic, or losing weight, it is important to discuss nutrition with the patients. Using a diet history can provide insight into the patient's usual eating pattern. Small frequent meals may be needed for anorexic patients, and supplementation for vitamin D, calcium, high protein, and iron may be needed (Danter, 2009).
Other nonpharmacologic therapies can also be beneficial. Activity and exercise are essential for maintaining good weight and joint mobility. Hydrotherapy or water exercise can help reduce the weight on the joint while moving during the exercises. Simple walking is also an excellent form of exercise with low physical impact.
Acupuncture is used for treating many chronic pain conditions. RA studies have shown that it is only effective when used in conjunction with medications; for OA, acupuncture has only been studied in knee and hip patients. Other therapies to consider for RA include ice and topical capsaicin creams (Danter, 2009).
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