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Arthritis: Chemotherapy Drugs to Treat Arthritis

In cancer treatment, chemotherapy refers to particular drugs used to kill or slow the reproduction of rapidly multiplying cells. In rheumatology, chemotherapy is designed to decrease the abnormal behavior of cells, rather than kill cells. The doses of medication used for rheumatic or autoimmune conditions are generally lower than the doses used for cancer treatment.

How Does Chemotherapy Treat Inflammatory and Autoimmune Diseases?

In many rheumatic diseases, inflammation causes damage to parts of the body; for example - causing painful joints as in rheumatoid arthritis. In many cases, inflammation results from autoimmunity, a malfunction of the immune system where one's own tissues or organs are not recognized as such and are attacked by the body's immune system.

Chemotherapy helps people with certain inflammatory and autoimmune diseases because it slows cell reproduction and decreases certain products made by these cells that cause an inflammatory response to occur.

What Chemotherapy Drugs Are Used to Treat Rheumatic Diseases?

Although there are many chemotherapy drugs, only some are used to treat rheumatic diseases today. These include:

Rheumatrex. Rheumatrex (methotrexate) is the chemotherapeutic drug most widely used by rheumatologists because it is effective in treating rheumatoid arthritis and certain other rheumatic diseases (such as certain forms of vasculitis, or inflammation of blood vessels), and it is relatively safe. Most patients can take Rheumatrex by mouth in a single, weekly dose. Some patients prefer to take it as an injection once a week. It’s common side effects are relatively easy to monitor, treat, and prevent.
Imuran. Imuran has been used for many years as an immunosuppressive drug to prevent organ rejection in patients receiving kidney transplants. Usually taken in a single daily dose by mouth, Imuran also is used to suppress the abnormal immune response in some patients with vasculitis, systemic lupus erythematosus (lupus), and rheumatoid arthritis.
Cytoxan. Cytoxan is a more powerful drug and has more side effects than Rheumatrex and Imuran. It is used to treat the most aggressive and dangerous rheumatic diseases and their complications, such as severe systemic lupus erythematosus and some forms of vasculitis. This drug, taken either by mouth or injection, directly attacks the parts of the cell nucleus that contain the genes interfering with the production of certain proteins. These proteins (antibodies) are involved with the autoimmune response. Although rapidly reproducing cells are more susceptible to this action than resting cells, any cell in the body can be affected if there is enough drugs present.

What Side Effects Do These Drugs Have?

Side effects of chemotherapeutic drugs are fairly common, even though the doses are typically lower than the doses used to treat cancer.

All of these drugs can suppress the formation of blood cells, resulting in:

Anemia or low red blood cell count. Red blood cells are the cells that carry oxygen throughout your body
Leukopenia/Neutropenia or low white blood cell count that may cause decreased ability to fight infection
Thrombocytopenia or low platelet count that may cause impaired blood clotting

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WebMD Medical Reference provided in collaboration with the Cleveland Clinic

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Important Safety Information you should know about HUMIRA® (adalimumab).

Serious infections have happened in patients receiving HUMIRA. These infections include TB (tuberculosis) and infections caused by viruses, fungi, or bacteria that have spread throughout the body. Some patients have died from these infections.

Before starting HUMIRA:

Tell your doctor if you think you have an infection, are being treated for an infection, have signs of an infection (such as a fever, cough, or flu-like symptoms), have any open sores on your body, have warm, red, or painful skin, get a lot of infections or have infections that keep coming back, have or had hepatitis B infection, take the medicine Kineret (anakinra), have TB or have been in close contact with someone who has TB, have lived in an area where TB or histoplasmosis is common, or were born in, lived in or traveled where there is more risk for getting TB. Your doctor should test you for TB before starting HUMIRA. If your doctor prescribes any medicine for the treatment of TB, you should start taking it before starting HUMIRA and take the full course of TB medicine prescribed.

Tell your doctor if you have any numbness or tingling, or have a disease that affects your nervous system such as multiple sclerosis or Guillain-Barré syndrome, have heart failure or other heart conditions, are scheduled for major surgery, are pregnant, become pregnant, plan to become pregnant or are breastfeeding. Tell your doctor if you are allergic to HUMIRA or any of its ingredients or are allergic to rubber or latex. The needle cover of the prefilled syringe and the pen contain dry natural rubber.

Also, tell your doctor if you have recently received or are scheduled for any vaccines. Except for live vaccines, patients may still receive vaccines while on HUMIRA. It is recommended that children with juvenile idiopathic arthritis be brought up to date with all immunizations prior to starting HUMIRA.

After starting HUMIRA:

Call your doctor right away if you get an infection, or any sign of an infection including a fever, feeling very tired, cough, flu-like symptoms, warm, red or painful skin or if you have any open sores on your body. HUMIRA can make you more likely to get infections or make any infection that you may have worse.

Possible side effects of HUMIRA:

Serious side effects, which sometimes lead to death, have happened in patients taking HUMIRA.

- Serious infections. These infections include TB (tuberculosis) and infections caused by viruses, fungi, or bacteria. Your doctor will examine you for TB and perform a test to see if you have TB. If your doctor feels that you are at risk for TB, you may be treated with medicine for TB before you begin treatment with HUMIRA and during treatment with HUMIRA. Even if your TB test is negative your doctor should carefully monitor you for TB infections while you are taking HUMIRA. Patients who had a negative TB skin test before receiving HUMIRA have developed active TB. Tell your doctor if you have any of the following symptoms while taking or after taking HUMIRA: cough, low-grade fever, weight loss, or loss of body fat and muscle.
- Certain types of cancer. There have been cases of certain kinds of cancer in patients taking HUMIRA or other TNF blockers. Patients with RA, especially more serious RA, may have a higher chance for getting a kind of cancer called lymphoma. Some patients receiving HUMIRA have developed types of cancer called non-melanoma skin cancer (basal cell cancer and squamous cell cancer of the skin), which are generally not life threatening if treated. Tell your doctor if you have a bump or open sore that doesn't heal.
- Allergic reactions. Signs of a serious allergic reaction include skin rash, a swollen face, or trouble breathing.
- Hepatitis B virus reactivation in patients that carry the virus in their blood. Tell your doctor if you have any of the following symptoms: feel unwell, poor appetite, fatigue, fever, rash or joint pain.
- Nervous system problems. Signs and symptoms include: numbness or tingling, problems with your vision, weakness in your arms or legs, and dizziness.
- Blood problems. Symptoms include a fever that does not go away, bruising or bleeding very easily, or looking very pale.
- New heart failure or worsening heart failure you already have. Symptoms include shortness of breath or swelling of your ankles or feet, or sudden weight gain.
- Immune reactions including a lupus-like syndrome. Symptoms include chest discomfort or pain that does not go away, shortness of breath, joint pain, or rash on your cheeks or arms that gets worse in the sun.

Call your doctor or get medical care right away if you develop any of the above symptoms. Your treatment with HUMIRA may be stopped.

Common side effects of HUMIRA are: injection site reactions (redness, rash, swelling, itching or bruising), upper respiratory infections (sinus infections), headaches, rash and nausea.

These are not all the side effects with HUMIRA. Ask your doctor or pharmacist for more information.

Information You Should Know About HUMIRA® (adalimumab).

HUMIRA is used to reduce the signs and symptoms of moderate to severe rheumatoidarthritis in adults, may prevent further damage to your bones and joints, and may help your ability to perform daily activities. HUMIRA can be used alone or with methotrexate or with certain other medicines. HUMIRA is used to reduce the signs and symptoms of moderate to severe polyarticular juvenile idiopathic arthritis in children 4 years of age and older. HUMIRA can be used alone or with methotrexate or with certain other medicines. HUMIRA is used to reduce the signs and symptoms of psoriatic arthritis in adults, may prevent further damage to your bones and joints, and may help your ability to perform daily activities. HUMIRA can be used alone or with certain other medicines. HUMIRA is used to reduce the signs and symptoms of ankylosing spondylitis in adults. HUMIRA is used to reduce the signs and symptoms of moderate to severe Crohn's disease in adults who have not responded well to conventional treatments. HUMIRA is also for these adults with moderate to severe Crohn's disease who have lost response or are unable to tolerate infliximab. HUMIRA is used to treat moderate to severe chronic (lasting a long time) plaque psoriasis in adults who are under the ongoing care of a physician, have the condition in many areas of their body and who may benefit from taking injections or pills (systemic therapy) or phototherapy (treatment using ultraviolet light alone or with pills).

HUMIRA is taken by injection.

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