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INTRODUCTION

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rilonacept (ri-lon-a-sept)

Arcalyst

Classification

Therapeutic: orphan drugs

Pharmacologic: fusion proteins, interleukin antagonists

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Indications
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Treatment of cryopyrin-associated periodic syndromes (CAPS), including familial cold autoinflammatory syndrome (FCAS) and Muckle-Wells syndrome (MWS).

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Action
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Modulates cryopyrin by blocking interleukin-1 beta (IL-1β), preventing its interaction with surface receptors. Therapeutic Effects: ↓ inflammatory manifestations of CAPS, including fever, rash, arthralgia, myalgia, fatigue, and conjunctivitis.

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Adverse Reactions/Side Effects
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Resp: upper respiratory tract infections, cough. Local: injection site reactions. Metab: changes in lipid profile. Neuro: hypoesthesia. Misc: SERIOUS LIFE-THREATENING INFECTIONS, hypersensitivity reactions.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Report any signs of infection, including upper respiratory tract infections. Signs of respiratory infection include cough, fever, nasal congestion, sneezing, runny nose, and sore throat.

  • Assess pain and other variables (range of motion, muscle strength) to document whether this drug is successful in helping manage muscle or joint pain associated with autoinflammatory conditions.

  • Assess any changes in sensation, including decreased sensitivity to touch (hypoesthesia) Perform objective tests including electroneuromyography and sensory testing to document any drug-related neuropathic changes.

  • Monitor signs of hypersensitivity reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

  • Assess the subcutaneous injection site for pain, swelling, and irritation. Report prolonged or excessive injection site reactions to the physician.

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Interventions
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  • Implement appropriate manual therapy techniques, physical agents, therapeutic exercises, and orthotic/assistive devices to reduce pain, improve function, and augment the effects of drug therapy.

  • Do not apply massage or physical agents (heat, cold, electrotherapeutic modalities) at or near the subcutaneous application site. These interventions can alter drug absorption from subcutaneous tissues.

  • Help patients explore other nonpharmacologic methods to reduce chronic musculoskeletal pain, such as relaxation techniques, exercise, counseling, and so forth.

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Patient/Client-Related Instruction
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  • Advise patient to guard against infection (frequent hand washing, etc.), and to avoid crowds and contact with persons with contagious diseases.

  • Advise patient that this drug may cause problems in fat metabolism. Remind patient that periodic blood tests may be needed to monitor plasma lipid profile.

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Pharmacokinetics
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Absorption: Absorbed following subcutaneous administration.

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Distribution: Unknown.

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Metabolism and Excretion: Unknown.

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Half-life: Unknown.

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TIME/ACTION PROFILE (improvement in symptoms)

ROUTE ONSET PEAK DURATION
SC within several days unknown unknown

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Contraindications/Precautions
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Contraindicated in: Active or chronic infections; OB: May cause fetal harm.

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Use Cautiously in: Patients at risk of infections; Lactation: Use cautiously; Pedi: Safety and effectiveness have not been established ...

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