Medications in Rheumatology
Mariana Gonzalez Trevino
Background
- "-cept" refers to fusion of a receptor to the Fc part of human immunoglobulin G1 (IgG1).
- "-mab" indicates a monoclonal antibody (mAb).
- "-ximab" indicates a chimeric mAb.
- "-zumab" indicates a humanized mAb.
- "-umab" indicates a fully human mAb.
- “-tinib” indicates a tyrosine kinase inhibitor (small molecule inhibitors, not true biologics).
Key Pearls for Inpatient Management (Always Confirm with Rheumatology)
- General approach to infections: For most DMARDs and biologics, hold during active infection and restart 7-14 days after symptom resolution for uncomplicated infections.
Hydroxychloroquine and sulfasalazine have relatively low infection risk and can often be continued. - Disease flare risk: Discontinuing DMARDs/biologics increases flare risk (31-61% in studies), which may necessitate rescue glucocorticoids and increase infection risk. Balance infection risk against disease control on a case-by-case basis.
- Drug interactions: Colchicine requires dose reduction or temporary hold with strong CYP3A4/Pgp inhibitors (clarithromycin, azoles, cyclosporine, ritonavir/Paxlovid).
- Renal/hepatic dysfunction: Adjust or hold methotrexate (CrCl <30), leflunomide (severe hepatic disease), colchicine (CrCl <30), and azathioprine (severe hepatic disease).
- Screening prior to initiation varies based on specific agent. Consider latent TB (via IGRA), Hepatitis B/C, HIV, age-appropriate cancer screening, pregnancy counseling. Discuss with rheumatology required vaccinations prior to treatment initiation.
