Anakinra

INTRODUCTION

Indications

Reduction of the signs and symptoms of moderately to severely active rheumatoid arthritis in patients who have failed other DMARDs (may be used in combination with other DMARDs other than tumor necrosis factor [TNF]–blocking agents).

Action

Blocks the destructive effects of interleukin-1 on cartilage and bone resorption by inhibiting its binding at specific tissue receptor sites. Therapeutic Effects: Slowed progression of rheumatoid arthritis. Adverse Reactions/Side Effects CNS: headache. GI: diarrhea, nausea. Hemat: neutropenia. Local: injection site reactions. Misc: INFECTIONS, hypersensitivity reactions (rare).

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Watch for signs of infection, especially respiratory infections as indicated by fatigue, chills, fever, night sweats, loss of appetite, and pulmonary pathology (persistent cough, coughing up blood, chest pain when breathing and coughing). Report these signs to the physician immediately.

• Although rare, be alert for signs of hypersensitivity 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.

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

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

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

Interventions

• 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

• Advise patient to guard against infection (frequent hand washing, etc.) and to avoid crowds and contact with persons with contagious diseases.

• Instruct patient to report other troublesome side effects, including severe or prolonged headache or GI problems (diarrhea, nausea).

Pharmacokinetics

Absorption: Well absorbed (95%) following SC administration.

Distribution: Unknown.

Metabolism and Excretion: Unknown.

Half-life: 4–6 hr.

Contraindications/Precautions

Contraindicated in: Active infections; Hypersensitivity; Hypersensitivity to other Escherichia coli–derived products.

Use Cautiously in: Other chronic debilitating illness; Underlying immunosuppression; Renal impairment; OB/Lactation/Pedi: Safety not established; Geri: May be more sensitive to toxicity ...