Tumor necrosis factor alpha inhibitors and methotrexate: implications for deployed personnel.
Rheumatic diseases such as rheumatoid and psoriatic arthritis are often diagnosed in younger age groups and are, therefore, likely to be encountered in active-duty military populations. These patients are increasingly being treated with disease modifying anti-rheumatic drugs (DMARDs) and biologic agents such as tumor necrosis factor alpha (TNF-alpha) inhibitors. While these classes of drugs have revolutionized the treatment of rheumatic diseases, they are also associated with serious potential adverse effects. At present, there are no published guidelines for the routine monitoring of laboratory parameters in patients receiving anti-TNF therapy. Currently, no official consensus among military physicians exists regarding duty and geographic limitations for patients receiving these types of therapy. Major adverse effects of these agents are reviewed in this article. A survey of U.S. Air Force, Army, and Navy rheumatologists was performed. The results of laboratory monitoring and operational deployment recommendations are reported. The majority of U.S. military rheumatologists do not recommend deployment of patients while taking methotrexate or TNF-alpha inhibitors.
Martin
Joseph J
JJ
Department of Rheumatology, Walter Reed Army Medical Center, 6900 Georgia Ave. NW, Washington, DC 20307-5001, USA. joseph.martin@amedd.army.mil
D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use; D008889:Military Personnel; D009363:Neoplasm Proteins / Q000009:adverse effects* / Q000627:therapeutic use; D047889:Receptors, Tumor Necrosis Factor, Type II / Q000627:therapeutic use; D012216:Rheumatic Diseases / Q000188:drug therapy*; D053319:Tumor Necrosis Factor Decoy Receptors; D014481:United States
D018501:Antirheumatic Agents; D009363:Neoplasm Proteins; D047889:Receptors, Tumor Necrosis Factor, Type II; D053319:Tumor Necrosis Factor Decoy Receptors; D008727:Methotrexate