Abstract
Objective: We evaluated the usefulness of tramadol/acetaminophen combination tablets (TRAM/APAP) for chronic pain in patients with rheumatoid arthritis (RA) who withdrew from treatment with biologics due to infection.
Subjects and methods:6 female RA patients with an average age of 67 years were received TRAM/APAP at our department. The disease durations ranged from 2 to 30 years (mean: 11years). The biologics used were infliximab, abatacept, and tocilizumab in 2 patients each. The infections were herpes zoster in 2 patients, and cellulitis, pyelonephritis, pneumonia,and conjun ctivitis in 1 patient each. All patients had also been receiving NSAIDs. The doses of TRAM/APAP were two tablets in 1 patient, three tablets in 4, and four tablets in 1. Efficacy was assessed by visual analog scale (VAS) at 4 and 8 weeks after administration.
Results: VAS scores were decreased at 4 weeks after administration in all patients. The mean VAS score decreased from 67.3mm before administration to 44.0mm at 4 weeks and 39.5mm at 8 weeks after administration, showing significant improvement. Adverse reactions occurred in 4 of the 6 patients, including drowsiness in 3 and nausea in 1. None of the patients discontinued treatment due to adverse reactions.
Conclusion: TRAM/APAP was considered to be among the potent treatment options for chronic pain difficult to control in RA patients withdrawing from treatment with biologics.
