Adalimumab

INTRODUCTION

Indications

Treatment of moderately to severely active rheumatoid arthritis in patients who have responded inadequately to other DMARDs; may be used with methotrexate or other DMARDs. Psoriatic arthritis. Active ankylosing spondylitis. Crohn's disease.

Action

Neutralizes and prevents the action of tumor necrosis factor (TNF), resulting in anti-inflammatory and antiproliferative activity. Therapeutic Effects: Decreased pain and swelling with decreased rate of joint destruction in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. Reduced signs and symptoms of Crohn's disease.

Adverse Reactions/Side Effects

CNS: headache. CV: hypertension. GI: abdominal pain, nausea. GU: hematuria. Derm: rash. Hemat: neutropenia, thrombocytopenia. Local: injection site reactions. Metab: hypercholesterolemia, hyperlipidemia. MS: back pain. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS, INFECTIONS (INCLUDING REACTIVATION TUBERCULOSIS).

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of allergic reactions and anaphylaxis, 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.

• Report any signs of infection, especially dormant tuberculosis that is reactivated by drug therapy (reactivation tuberculosis). Signs include fatigue, chills, fever, night sweats, loss of appetite, and pulmonary pathology (persistent cough, coughing up blood, chest pain when breathing and coughing).

• Monitor and report signs of neutropenia (fever, sore throat, signs of infection) or thrombocytopenia (bruising, nose bleeds, and bleeding gums). Periodic blood tests may be needed to monitor WBC and RBC counts.

• 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 blood pressure periodically, and compare to normal values (see Appendix F). Report a sustained increase in BP (hypertension).

• If treating arthritic conditions, periodically assess impairments (pain, range of motion), functional ability, and disability to help document whether antirheumatic drug therapy is successful.

• If treating inflammatory bowel diseases, monitor any changes in symptoms (decreased abdominal pain, decreased diarrhea, improved appetite) to help determine if drug therapy is successful.

• If treating psoriasis, monitor skin responses to help determine if drug therapy is successful in resolving this condition.

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

Interventions

• If treating arthritic conditions, implement appropriate manual therapy techniques, physical agents, therapeutic exercises, and orthotic/assistive devices to reduce pain, improve function, and augment the effects of antirheumatic 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