A 52-year-old woman with RAhas been controlled with methotrexate and Celebrex for 10 years. Recently she has experienced increased joint pain and swelling and rheumatologist plans to add adalimumab (Humira) to her drug regimen. Issues:
1) before starting Humira, coverage by this patient’s insurance company will need to be explored.
2) Serious infections have occurred in people taking Humira, including tuberculosis and infections caused by viruses, fungi, or bacteria that have spread throughout the body. Determine whether the patient has had a recent negative purified protein derivative (PPD) test. If not, a PPD skin test is typically administered and the selected BRM is not started until the results are known to be negative. Collaborate with the health care provider to ensure that this process is complete.
3) What health teaching will she need before starting Humira?The signs and symptoms of an allergic reaction should be reviewed (rash, swollen face, difficulty breathing), with the patient told to seek emergency care immediately if these occur. Injection site reactions (e.g., redness, rash, swelling, itching, and bruising) may occur but are usually mild and transient. Apply a towel soaked with cold water to the injection site if it hurts or remains swollen. Call the provider immediately if the reaction does not disappear or seems to worsen. Tuberculosis may occur during adalimumab therapy. Report persistent cough, wasting or weight loss, and low-grade fever to the provider. The patient must be taught to recognize evidence of infection and bleeding disorders and to tell the provider if they occur; the drug may need to be stopped. Avoid people with infections and keep follow-up appointments for all prescribed laboratory tests.