Name of the Procedure:

Leflunomide Therapy
Common name(s): Leflunomide Technical/Medical term(s): Leflunomide administration, Arava treatment

Summary

Leflunomide is an oral medication used to manage symptoms of rheumatoid arthritis and other autoimmune conditions. It works by suppressing the immune system to reduce inflammation and slow disease progression.

Purpose

Leflunomide is primarily used to treat rheumatoid arthritis. The medication aims to reduce inflammation, decrease pain and swelling, improve physical function, and prevent further joint damage.

Indications

• Moderate to severe rheumatoid arthritis
• Psoriatic arthritis

Patient criteria:

• Adults diagnosed with rheumatoid arthritis or psoriatic arthritis
• Patients for whom other treatments have not been effective

Preparation

• Blood tests to assess liver function and blood cell counts
• Pregnancy test for women of childbearing age
• Discontinuation of any existing medications that may interact with leflunomide

Procedure Description

1. Initial Consultation: Confirmation of diagnosis and discussion of treatment.
2. Prescription: The healthcare provider prescribes leflunomide, typically starting with a loading dose followed by a maintenance dose.
3. Oral Intake: The patient takes the prescribed dosage orally once per day, with or without food.
4. Monitoring: Regular blood tests to monitor liver function and blood cell counts to ensure no adverse effects are developing.

Duration

Ongoing, with continual daily intake as long as treatment is necessary and effective.

Setting

Typically managed as an outpatient treatment with regular follow-up visits to the healthcare provider.

Personnel

• Primary Care Physician or Rheumatologist
• Nurse (for initial instruction and monitoring)
• Pharmacist (for dispensing medication and counseling on use)

Risks and Complications

Common:

• Nausea, diarrhea, or abdominal pain
• Elevated liver enzymes
• Hair loss

Rare:

• Severe liver damage
• Severe hypertension
• Blood cell count abnormalities

Benefits

• Reduced pain and swelling
• Slowed progression of joint damage
• Improved daily functional capacity

Recovery

• No immediate recovery period since it is an ongoing therapy.
• Regular follow-ups for blood tests and health assessments.
• Patients may need periodic liver function tests and blood counts.

Alternatives

• Methotrexate
• Sulfasalazine
• Biologics (e.g., TNF inhibitors, IL-6 inhibitors)

Pros and Cons:

• Methotrexate: Often first line, but some patients may not respond well.
• Biologics: More targeted but can be expensive and have different risk profiles.

Patient Experience

Patients are likely to experience reduced pain and inflammation with ongoing use. Initial side effects like gastrointestinal discomfort are common but often diminish over time. Pain management and comfort measures are managed with follow-up consultations to adjust therapy if needed.