allopurinol and Rheumatic-Diseases

Rapid and effective suppression of inflammation is a primary goal in the treatment of rheumatic diseases. However, the therapeutic effect of most medications may be slow to manifest, in the order of weeks or months in the case of DMARDs. Monitoring of drug concentrations allows the possibility of appropriate dose adjustment or changes in medication to achieve more rapid or better outcomes. We review the evidence for drug concentration monitoring. Despite the theoretical utility for monitoring of MTX polyglutamate concentrations in red blood cells in patients with RA, studies have not shown a clear association between concentrations and either efficacy or toxicity and routine measurement is not yet recommended. Small studies associating disease control with concentrations of anti-TNF therapies and anti-drug antibodies suggest that routine monitoring may be useful in the future. However, the data are not yet sufficient for this recommendation. With the use of allopurinol in gout, there is a putative therapeutic range for the active metabolite oxypurinol; however, adjusting the allopurinol dose to achieve a target urate concentration is likely to be most effective, and measuring oxypurinol may be best suited to assessing drug adherence. Although measuring thiopurine metabolite concentrations with AZA therapy has been shown to be useful in IBD, studies in rheumatic diseases have so far failed to confirm a useful association between concentrations and disease control or drug toxicity. Whole blood concentrations of HCQ have been associated with disease control in SLE and future studies may be able to determine a therapeutic range.

Topics: Allopurinol; Antirheumatic Agents; Arthritis, Rheumatoid; Drug Monitoring; Gout Suppressants; Humans; Methotrexate; Rheumatic Diseases; Tumor Necrosis Factor-alpha

Topics: Allopurinol; Anti-Inflammatory Agents; Arthritis, Rheumatoid; Gold; Gout; Humans; Lupus Erythematosus, Systemic; Osteoarthritis; Penicillamine; Rheumatic Diseases; Salicylates; Spondylitis, Ankylosing; Vasculitis

Topics: Humans; Lesch-Nyhan Syndrome; Metabolism, Inborn Errors; Pentosyltransferases; Purines; Rheumatic Diseases; Xanthine Oxidase

Topics: Adrenocorticotropic Hormone; Allopurinol; Analgesics; Arthritis, Juvenile; Arthritis, Rheumatoid; Colchicine; Diagnosis, Differential; Gold; Gout; Humans; Phenylbutazone; Probenecid; Prognosis; Rheumatic Diseases; Rheumatic Fever

Topics: Allopurinol; Anti-Inflammatory Agents; Arthritis; Azathioprine; Chloroquine; Cyclophosphamide; Glucocorticoids; Humans; Immunosuppressive Agents; Indomethacin; Methotrexate; Nitrogen Mustard Compounds; Rheumatic Diseases; Salicylates

Topics: Allopurinol; Arthritis, Rheumatoid; Azathioprine; Blood Cells; Capsules; Clinical Trials as Topic; Eye Diseases; Female; Gastrointestinal Diseases; Gout; Humans; Indomethacin; Lupus Erythematosus, Systemic; Male; Middle Aged; Rheumatic Diseases; Scleroderma, Systemic; Spondylitis, Ankylosing; Suppositories

Sera of patients with various inflammatory and autoimmune rheumatic diseases were screened for the presence of xanthine oxidase (XOD) and compared to sera from healthy donors and patients with nonrheumatic diseases including AIDS, internal diseases, and different carcinomas. Up to 50-fold higher levels of XOD were detected in rheumatic sera (P < 0.001). In addition, serum sulfhydryls (SH) were determined as sensitive markers of oxidative stress. The SH status in rheumatic patients was diminished by 45-75% (P < 0.001) and inversely correlated to the concentration of serum XOD (R = 0.73), suggesting a causal interrelation. The depletion of serum sulfhydryls by the oxyradical-producing XOD/acetaldehyde system was mimicked successfully ex vivo in human serum from healthy donors. Cortisone treatment of patients suffering from systemic lupus erythematosus and rheumatoid arthritis impressively normalized elevated XOD concentrations in rheumatic sera to those of healthy controls. The participation of xanthine oxidase in the depletion of serum antioxidants in rheumatic patients is discussed in the light of substrate availability and Km values.

Topics: Acetaldehyde; Acquired Immunodeficiency Syndrome; Autoimmune Diseases; Biomarkers; Cohort Studies; Cortisone; Female; Humans; Inflammation; Internal Medicine; Male; Metallothionein; Neoplasms; Organometallic Compounds; Oxidation-Reduction; Oxygen; Rheumatic Diseases; Schiff Bases; Singlet Oxygen; Stress, Physiological; Sulfhydryl Compounds; Xanthine Oxidase

Topics: Allopurinol; Anti-Inflammatory Agents; Diclofenac; Glucocorticoids; Humans; Indomethacin; Rheumatic Diseases

Topics: Aged; Allopurinol; Gout; Humans; Joint Diseases; Osteitis Deformans; Rheumatic Diseases; Uricosuric Agents

Topics: Allopurinol; Arthritis; Arthritis, Rheumatoid; Ohio; Rheumatic Diseases; Societies, Medical