Leflunomide

INTRODUCTION

Indications

Rheumatoid arthritis (disease-modifying agent).

Action

Inhibits an enzyme required for pyrimidine synthesis; has antiproliferative and anti-inflammatory effects. Therapeutic Effects: Decreased pain and inflammation, slowed structural progression, and improved physical function.

Adverse Reactions/Side Effects

CNS: headache, dizziness, weakness. Resp: bronchitis, increased cough, pharyngitis, pneumonia, respiratory infection, rhinitis, sinusitis. CV: chest pain, hypertension. GI: diarrhea, nausea, abdominal pain, abnormal liver enzymes, hepatotoxicity (rare), anorexia, dyspepsia, gastroenteritis, mouth ulcers, vomiting. GU: urinary tract infection. Derm: alopecia, rash, dry skin, eczema, pruritus. F and E: hypokalemia. Metab: weight loss. MS: arthralgia, back pain, joint disorder, leg cramps, synovitis, tenosynovitis. Neuro: paresthesia. Misc: allergic reactions, flu syndrome, infections, including sepsis, pain.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess pulmonary function periodically by measuring lung volumes, breath sounds, and respiratory rate (See Appendices I, J, K). Notify physician immediately if patient experiences signs of pneumonia (cough, fever, chills, chest pain during inspiration and expiration) or other respiratory problems (bronchitis, rhinitis, sinusitis, pharyngitis).

• Periodically assess impairments (pain, range of motion), functional ability, and disability to help determine if antirheumatic drug therapy is successful.

• Assess any new or increased back pain, joint pain, or other musculoskeletal problems 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 signs of paresthesia (numbness, tingling) or muscle twitching. Perform objective tests, including electroneuromyography and sensory testing to document any drug-related neuropathic changes.

• Monitor any other muscle weakness, aches, or cramps that might indicate low potassium levels (hypokalemia).

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

• Assess dizziness or weakness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Assess blood pressure (BP) periodically and compare to normal values (See Appendix F). Report a sustained increase in BP (hypertension) or recurrent episodes of chest pain.

Interventions

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

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

Patient/Client-Related Instruction

• Advise patient about the likelihood of GI reactions (nausea, vomiting, diarrhea, mouth sores, heartburn). Instruct patient ...