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INTRODUCTION

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infliximab (in-flix-i-mab)

Remicade

Classification

Therapeutic: antirheumatics (disease-modifying antirheumatic drugs, DMARDs), gastrointestinal anti-inflammatories—therapeutic

Pharmacologic: monoclonal antibodies

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Indications
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Active rheumatoid arthritis (moderate-to-severe, with methotrexate). Active Crohn's disease (moderate-to-severe). Active psoriatic arthritis. Active ankylosing spondylitis. Active ulcerative colitis (moderate-to-severe) with inadequate response to conventional therapy: reducing signs and symptoms, inducing and maintaining clinical remission and mucosal healing, and eliminating corticosteroid use. Plaque psoriasis (chronic severe).

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Action
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Neutralizes and prevents the activity of tumor necrosis factor-alpha (TNF-alpha), resulting in anti-inflammatory and antiproliferative activity. Therapeutic Effects: Decreased pain and swelling, decreased rate of joint destruction and improved physical function in ankylosing spondylitis, rheumatoid or psoriatic arthritis. Reduction and maintenance of closure of fistulae in Crohn's disease. Decreased symptoms, maintaining remission and mucosal healing with decreased corticosteroid use in ulcerative colitis. Decrease in duration, scaling, and erythema of psoriatic lesions.

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Adverse Reactions/Side Effects
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CNS: fatigue, headache, anxiety, depression, dizziness, insomnia. EENT: conjunctivitis. Resp: upper respiratory tract infection, bronchitis, cough, dyspnea, laryngitis, pharyngitis, respiratory tract allergic reaction, rhinitis, sinusitis. CV: chest pain, hypertension, hypotension, pericardial effusion, tachycardia, CHF. GI: abdominal pain, nausea, vomiting, constipation, diarrhea, dyspepsia, flatulence, hepatotoxicity, intestinal obstruction, oral pain, tooth pain, ulcerative stomatitis. GU: dysuria, urinary frequency, urinary tract infection. Derm: acne, alopecia, dry skin, ecchymosis, eczema, erythema, flushing, hematoma, increased sweating, hot flushes, pruritus, urticaria, rash. Hemat: neutropenia. MS: arthralgia, arthritis, back pain, involuntary muscle contractions, myalgia. Neuro: paresthesia. Misc: INFECTIONS(INCLUDING REACTIVATION TUBERCULOSIS, PNEUMONIA AND INVASIVE FUNGAL INFECTIONS), fever, infusion reactions, chills, flu-like syndrome, herpes simplex, herpes zoster, hypersensitivity reactions, ↑ risk of lymphoma, lupus-like syndrome, moniliasis, pain, peripheral edema, vasculitis.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Watch for any signs of infection, especially pulmonary signs associated with pneumonia, invasive fungal infections, or dormant tuberculosis that is reactivated by drug therapy (reactivation tuberculosis). Common pulmonary signs of infection include persistent cough, dyspnea, chest pain, coughing up blood, fatigue, fever, chills, and loss of appetite. Report these signs to the physician immediately.

  • Monitor signs of hypersensitivity reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Be especially alert for allergy-like responses that occur during and after administration (infusion reactions). Notify physician immediately if these reactions occur.

  • Monitor and report signs of neutropenia such as fever, sore throat, and signs of infection. Periodic blood tests may be needed to monitor WBC and RBC counts.

  • Assess any new or increased back, joint, or muscle pain and spasms to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by arthritis or anatomic and biomechanical problems.

  • Assess blood pressure (BP) and compare to normal values (See Appendix F). Report changes in BP, either a problematic decrease ...

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