Generic drug: cyclosporine
Brand name: Sandimmune
What is Sandimmune (cyclosporine), and how does it work?
Sandimmune (cyclosporine) is indicated for the prophylaxis of organ rejection in kidney, liver, and heart allogeneic transplants. It is always to be used with adrenal corticosteroids. The drug may also be used in the treatment of chronic rejection in patients previously treated with other immunosuppressive agents.
Because of the risk of anaphylaxis, Sandimmune Injection (cyclosporine injection, USP) should be reserved for patients who are unable to take the soft gelatin capsules or oral solution.
What are the side effects of Sandimmune?
The principal adverse reactions of Sandimmune (cyclosporine) therapy are
- renal dysfunction,
- hypertension, and
- gum hyperplasia.
- Hypertension, which is usually mild to moderate, may occur in approximately 50% of patients following renal transplantation and in most cardiac transplant patients.
Glomerular Capillary Thrombosis
- Glomerular capillary thrombosis has been found in patients treated with cyclosporine and may progress to graft failure.
- The pathologic changes resemble those seen in the hemolytic-uremic syndrome and include thrombosis of the renal microvasculature, with platelet-fibrin thrombi occluding glomerular capillaries and afferent arterioles, microangiopathic hemolytic anemia, thrombocytopenia, and decreased renal function.
- Similar findings have been observed when other immunosuppressives have been employed post transplantation.
- Hypomagnesemia has been reported in some, but not all, patients exhibiting convulsions while on cyclosporine therapy.
- Although magnesium-depletion studies in normal subjects suggest that hypomagnesemia is associated with neurologic disorders, multiple factors, including hypertension, high-dose methylprednisolone, hypocholesterolemia, and nephrotoxicity associated with high plasma concentrations of cyclosporine appear to be related to the neurological manifestations of cyclosporine toxicity.
The following reactions occurred in 3% or greater of 892 patients involved in clinical trials of kidney, heart, and liver transplants:
|Body System/ Adverse Reactions||Randomized Kidney Patients||All Sandiimmune (cyclosporine) Patients|
|Cramps||4||< 1||2||< 1||0|
|Central Nervous System|
|Hepatotoxicity||< 1||< 1||4||7||4|
|Abdominal Discomfort||< 1||0||< 1||7||0|
|Autonomic Nervous System|
|Gynecomastia||< 1||0||< 1||4||3|
The following reactions occurred in 2% or less of patients:
- allergic reactions,
- brittle fingernails,
- hearing loss,
- muscle pain,
- peptic ulcer,
The following reactions occurred rarely:
- chest pain,
- hair breaking,
- joint pain,
- mouth sores,
- myocardial infarction,
- night sweats,
- swallowing difficulty,
- upper GI bleeding,
- visual disturbance,
- weight loss.
Renal Transplant Patients in Whom Therapy Was Discontinued
|Reason for Discontinuation||Randomized Patients||All Sandimmune Patients|
|Lack of Efficacy||2.6||0.9||1.4|
|Acute Tubular Necrosis||2.6||0||1.0|
- Sandimmune (cyclosporine) was discontinued on a temporary basis and then restarted in 18 additional patients.
- Patients receiving immunosuppressive therapies, including cyclosporine and cyclosporine -containing regimens, are at increased risk of infections (viral, bacterial, fungal, parasitic).
- Both generalized and localized infections can occur. Pre-existing infections may also be aggravated.
- Fatal outcomes have been reported.
Infectious Complications in the Randomized Renal Transplant Patients
(N=227) % of Complications
(N=228) % of Complications
|Systemic Fungal Infection||2.2||3.9|
|Local Fungal Infection||7.5||9.6|
|Other Viral Infections||15.9||18.4|
|Urinary Tract Infections||21.1||20.2|
|Wound and Skin Infections||7.0||10.1|
|*Some patients also received ALG.|
- Cremophor EL (polyoxyethylated castor oil) is known to cause hyperlipemia and electrophoretic abnormalities of lipoproteins.
- These effects are reversible upon discontinuation of treatment but are usually not a reason to stop treatment.
- Cases of hepatotoxicity and liver injury including cholestasis, jaundice, hepatitis and liver failure; serious and/or fatal outcomes have been reported.
Increased Risk of Infections
- Cases of JC virus-associated progressive multifocal leukoencephalopathy (PML), sometimes fatal; and polyoma virus-associated nephropathy (PVAN), especially BK virus resulting in graft loss have been reported.
Headache, including Migraine
- Cases of migraine have been reported. In some cases, patients have been unable to continue cyclosporine, however, the final decision on treatment discontinuation should be made by the treating physician following the careful assessment of benefits versus risks.
Pain of Lower Extremities
What is the dosage for Sandimmune?
Sandimmune Soft Gelatin Capsules (cyclosporine capsules, USP) and Sandimmune Oral Solution (cyclosporine oral solution, USP)
- Sandimmune Soft Gelatin Capsules (cyclosporine capsules, USP) and Sandimmune Oral Solution (cyclosporine oral solution, USP) have decreased bioavailability in comparison to Neoral Soft Gelatin Capsules (cyclosporine capsules, USP) MODIFIED and Neoral Oral Solution (cyclosporine oral solution, USP) MODIFIED. Sandimmune and Neoral are not bioequivalent and cannot be used interchangeably without physician supervision.
- The initial oral dose of Sandimmune (cyclosporine) should be given 4 to 12 hours prior to transplantation as a single dose of 15 mg/kg.
- Although a daily single dose of 14 to 18 mg/kg was used in most clinical trials, few centers continue to use the highest dose, most favoring the lower end of the scale.
- There is a trend towards use of even lower initial doses for renal transplantation in the ranges of 10 to 14 mg/kg/day.
- The initial single daily dose is continued postoperatively for 1 to 2 weeks and then tapered by 5% per week to a maintenance dose of 5 to 10 mg/kg/day.
- Some centers have successfully tapered the maintenance dose to as low as 3 mg/kg/day in selected renal transplant patients without an apparent rise in rejection rate.
(See Blood Concentration Monitoring, below)
- Cyclosporine undergoes minimal renal elimination and its pharmacokinetics do not appear to be significantly altered in patients with end-stage renal disease who receive routine hemodialysis treatments.
- However, due to its nephrotoxic potential, careful monitoring of renal function is recommended; cyclosporine dosage should be reduced if indicated.
- The clearance of cyclosporine may be significantly reduced in severe liver disease patients.
- Dose reduction may be necessary in patients with severe liver impairment to maintain blood concentrations within the recommended target range.
- In pediatric usage, the same dose and dosing regimen may be used as in adults although in several studies, children have required and tolerated higher doses than those used in adults.
- Adjunct therapy with adrenal corticosteroids is
recommended. Different tapering dosage schedules of prednisone appear to
achieve similar results.
- A dosage schedule based on the patient's weight started with 2.0 mg/kg/day for the first 4 days tapered to 1.0 mg/kg/day by 1 week, 0.6 mg/kg/day by 2 weeks, 0.3 mg/kg/day by 1 month, and 0.15 mg/kg/day by 2 months and thereafter as a maintenance dose.
- Another center started with an initial dose of 200 mg tapered by 40 mg/day until reaching 20 mg/day.
- After 2 months at this dose, a further reduction to 10 mg/day was made. Adjustments in dosage of prednisone must be made according to the clinical situation.
- To make Sandimmune Oral Solution (cyclosporine oral solution, USP) more palatable, the oral solution may be diluted with milk, chocolate milk, or orange juice preferably at room temperature. Patients should avoid switching diluents frequently.
- Sandimmune Soft Gelatin Capsules and Oral Solution should be administered on a consistent schedule with regard to time of day and relation to meals.
- Take the prescribed amount of Sandimmune (cyclosporine)
from the container using the dosage syringe supplied after removal of the
protective cover, and transfer the solution to a glass of milk, chocolate milk,
or orange juice.
- Stir well and drink at once. Do not allow to stand before drinking.
- It is best to use a glass container and rinse it with more diluent to ensure that the total dose is taken.
- After use, replace the dosage syringe in the protective cover.
- Do not rinse the dosage syringe with water or other cleaning agents either before or after use.
- If the dosage syringe requires cleaning, it must be completely dry before resuming use. Introduction of water into the product by any means will cause variation in dose.
Sandimmune Injection (cyclosporine injection, USP)
FOR INFUSION ONLY
Note: Anaphylactic reactions have occurred with Sandimmune Injection (cyclosporine injection, USP).
- Patients unable to take Sandimmune Soft Gelatin Capsules or Oral Solution pre-or postoperatively may be treated with the intravenous (IV) concentrate.
- Sandimmune Injection (cyclosporine injection, USP) is administered at 1/3 the oral dose.
- The initial dose of Sandimmune Injection (cyclosporine injection, USP) should be given 4 to 12 hours prior to transplantation as a single intravenous dose of 5 to 6 mg/kg/day. This daily single dose is continued postoperatively until the patient can tolerate the soft gelatin capsules or oral solution.
- Patients should be switched to Sandimmune Soft Gelatin Capsules or Oral Solution as soon as possible after surgery.
- In pediatric usage, the same dose and dosing regimen may be used, although higher doses may be required.
- Adjunct steroid therapy is to be used. (See aforementioned.)
- Immediately before use, the intravenous concentrate should be diluted 1 mL Sandimmune Injection (cyclosporine injection, USP) in 20 mL to 100 mL 0.9% Sodium Chloride Injection or 5% Dextrose Injection and given in a slow intravenous infusion over approximately 2 to 6 hours.
- Diluted infusion solutions should be discarded after 24 hours.
- The Cremophor EL (polyoxyethylated castor oil) contained in the concentrate for intravenous infusion can cause phthalate stripping from PVC.
- Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.
Blood Concentration Monitoring
- Several study centers have found blood concentration monitoring of cyclosporine useful in patient management.
- While no fixed relationships have yet been established, in one series of 375 consecutive cadaveric renal transplant recipients, dosage was adjusted to achieve specific whole blood 24-hour trough concentrations of 100 to 200 ng/mL as determined by high-pressure liquid chromatography (HPLC).
- Of major importance to blood concentration analysis is the type of assay used.
- The above concentrations are specific to the parent cyclosporine molecule and correlate directly to the new monoclonal specific radioimmunoassays (mRIA-sp). Nonspecific assays are also available which detect the parent compound molecule and various of its metabolites.
- Older studies often cited concentrations using a nonspecific assay which were roughly twice those of specific assays. Assay results are not interchangeable and their use should be guided by their approved labeling.
- If plasma specimens are employed, concentrations will vary with the temperature at the time of separation from whole blood. Plasma concentrations may range from ½ to 1/5 of whole blood concentrations. Refer to individual assay labeling for complete instructions.
- In addition, Transplantation Proceedings (June 1990) contains position papers and a broad consensus generated at the Cyclosporine-Therapeutic Drug Monitoring conference that year. Blood concentration monitoring is not a replacement for renal function monitoring or tissue biopsies.
What drugs interact with Sandimmune?
Effect Of Drugs And Other Agents On Cyclosporine Pharmacokinetics And/Or Safety
All of the individual drugs cited below are well substantiated to interact with cyclosporine. In addition, concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs) with cyclosporine, particularly in the setting of dehydration, may potentiate renal dysfunction. Caution should be exercised when using other drugs which are known to impair renal function.
Drugs That May Potentiate Renal Dysfunction
|Antibiotics||Antineoplastic||Antifungals||Anti- Inflammatory Drugs||Gastrointestinal Agents||Immunosuppressives||Other Drugs|
|ciprofloxacin||melphalan||amphotericin B||azapropazon||cimetidine||tacrolimus||fibric acid derivatives (e.g., bezafibrate, fenofibrate)|
|trimethoprim with sulfamethoxazole||naproxen|
- During the concomitant use of a drug that may exhibit additive or synergistic renal impairment potential with cyclosporine, close monitoring of renal function (in particular serum creatinine) should be performed.
- If a significant impairment of renal function occurs, reduction in the dosage of cyclosporine and/or coadministered drug or an alternative treatment should be considered.
- Cyclosporine is extensively metabolized by CYP 3A isoenzymes, in particular CYP3A4, and is a substrate of the multidrug efflux transporter P-glycoprotein.
- Various agents are known to either increase or decrease plasma or whole blood concentrations of cyclosporine usually by inhibition or induction of CYP3A4 or P-glycoprotein transporter or both.
- Compounds that decrease cyclosporine absorption such as orlistat should be avoided.
- Appropriate Sandimmune (cyclosporine) dosage adjustment to achieve the desired cyclosporine concentrations is essential when drugs that significantly alter cyclosporine concentrations are used concomitantly. (See Blood Concentration Monitoring)
Drugs That Increase Cyclosporine Concentrations
|Calcium Channel Blockers||Antifungals||Antibiotics||Glucocorticoids||Other Drugs|
HIV Protease inhibitors
- The HIV protease inhibitors (e.g., indinavir, nelfinavir, ritonavir, and saquinavir) are known to inhibit cytochrome P-450 3A and thus could potentially increase the concentrations of cyclosporine, however no formal studies of the interaction are available.
- Care should be exercised when these drugs are administered concomitantly.
- Grapefruit and grapefruit juice affect metabolism, increasing blood concentrations of cyclosporine, thus should be avoided.
Drugs/Dietary Supplements That Decrease Cyclosporine Concentrations
|Antibiotics||Anticonvulsants||Other Drugs /Dietary Supplements|
|St. John's Wort|
- Co-administration of bosentan (250 to 1000 mg every 12 hours based on tolerability) and cyclosporine (300 mg every 12 hours for 2 days then dosing to achieve a Cmin of 200 to 250 ng/mL) for 7 days in healthy subjects resulted in decreases in the cyclosporine mean dose-normalized AUC, Cmax, and trough concentration of approximately 50%, 30% and 60%, respectively, compared to when cyclosporine was given alone. (See also Effect of Cyclosporine on the Pharmacokinetics and/or Safety of Other Drugs or Agents) Coadministration of cyclosporine with bosentan should be avoided.
- Coadministration of boceprevir (800 mg three times daily for 7 days) and cyclosporine (100 mg single dose) in healthy subjects resulted in increases in the mean AUC and Cmax of cyclosporine approximately 2.7-fold and 2-fold, respectively, compared to when cyclosporine was given alone.
- Coadministration of telaprevir (750 mg every 8 hours for 11 days) with cyclosporine (10 mg on day 8) in healthy subjects resulted in increases in the mean dose-normalized AUC and Cmax of cyclosporine approximately 4.5-fold and 1.3-fold, respectively, compared to when cyclosporine (100 mg single dose) was given alone.
St. John's Wort
- There have been reports of a serious drug interaction between cyclosporine and the herbal dietary supplement, St. John's Wort. This interaction has been reported to produce a marked reduction in the blood concentrations of cyclosporine, resulting in subtherapeutic levels, rejection of transplanted organs, and graft loss.
- Rifabutin is known to increase the metabolism of other drugs metabolized by the cytochrome P-450 system. The interaction between rifabutin and cyclosporine has not been studied. Care should be exercised when these two drugs are administered concomitantly.
Effect Of Cyclosporine On The Pharmacokinetics And/Or Safety Of Other Drugs Or Agents
- Cyclosporine is an inhibitor of CYP3A4 and of multiple drug efflux transporters (e.g., P-glycoprotein) and may increase plasma concentrations of comedications that are substrates of CYP3A4, Pglycoprotein, or organic anion transporter proteins.
- Cyclosporine may reduce the clearance of digoxin, colchicine, prednisolone, HMG-CoA reductase inhibitors (statins) and aliskiren, bosentan, dabigatran, repaglinide, NSAIDs, sirolimus, etoposide, and other drugs.
- See the full prescribing information of the other drug for further information and specific recommendations. The decision on coadministration of cyclosporine with other drugs or agents should be made by the healthcare provider following the careful assessment of benefits and risks.
- Severe digitalis toxicity has been seen within days of starting cyclosporine in several patients taking digoxin. If digoxin is used concurrently with cyclosporine, serum digoxin concentrations should be monitored.
- There are reports on the potential of cyclosporine to enhance the toxic effects of colchicine such as myopathy and neuropathy, especially in patients with renal dysfunction.
- Concomitant administration of cyclosporine and colchicine results in significant increases in colchicine plasma concentrations. If colchicine is used concurrently with cyclosporine, a reduction in the dosage of colchicine is recommended.
HMG Co-A Reductase Inhibitors (statins)
- Literature and postmarketing cases of myotoxicity, including muscle pain and weakness, myositis, and rhabdomyolysis, have been reported with concomitant administration of cyclosporine with lovastatin, simvastatin, atorvastatin, pravastatin, and rarely, fluvastatin.
- When concurrently administered with cyclosporine, the dosage of these statins should be reduced according to label recommendations.
- Statin therapy needs to be temporarily withheld or discontinued in patients with signs and symptoms of myopathy or those with risk factors predisposing to severe renal injury, including renal failure, secondary to rhabdomyolysis.
- Cyclosporine may increase the plasma concentrations of repaglinide and thereby increase the risk of hypoglycemia.
- In 12 healthy male subjects who received two doses of 100 mg cyclosporine capsule orally 12 hours apart with a single dose of 0.25 mg repaglinide tablet (one half of a 0.5 mg tablet) orally 13 hours after the cyclosporine initial dose, the repaglinide mean Cmax and AUC were increased 1.8 fold (range: 0.6 to 3.7 fold) and 2.4 fold (range 1.2 to 5.3 fold), respectively.
- Close monitoring of blood glucose level is advisable for a patient taking cyclosporine and repaglinide concomitantly.
- Coadministration of ambrisentan (5 mg daily) and cyclosporine (100 to 150 mg twice daily initially, then dosing to achieve Cmin 150 to 200 ng/mL) for 8 days in healthy subjects resulted mean increases in ambrisentan AUC and Cmax of approximately 2-fold and 1.5-fold, respectively, compared to ambrisentan alone.
- When coadministering ambrisentan with cyclosporine, the ambrisentan dose should not be titrated to the recommended maximum daily dose.
- High doses of cyclosporine (e.g., at starting intravenous dose of 16 mg/kg/day) may increase the exposure to anthracycline antibiotics (e.g., doxorubicin, mitoxantrone, daunorubicin) in cancer patients.
- Cyclosporine alters the pharmacokinetics of aliskiren, a substrate of P-glycoprotein and CYP3A4. In 14 healthy subjects who received concomitantly single doses of cyclosporine (200 mg) and reduced dose aliskiren (75 mg), the mean Cmax of aliskiren was increased by approximately 2.5-fold (90% CI: 1.96 to 3.17) and the mean AUC by approximately 4.3 fold (90% CI: 3.52 to 5.21), compared to when these subjects received aliskiren alone.
- The concomitant administration of aliskiren with cyclosporine prolonged the median aliskiren elimination half-life (26 hours versus 43 to 45 hours) and the Tmax (0.5 hours versus 1.5 to 2.0 hours).
- The mean AUC and Cmax of cyclosporine were comparable to reported literature values.
- Coadministration of cyclosporine and aliskiren in these subjects also resulted in an increase in the number and/or intensity of adverse events, mainly headache, hot flush, nausea, vomiting, and somnolence. The coadministration of cyclosporine with aliskiren is not recommended.
- In healthy subjects, coadministration of bosentan and cyclosporine resulted in time-dependent mean increases in dose-normalized bosentan trough concentrations (i.e., approximately 21-fold on day 1 and 2-fold on day 8 (steady state)) compared to when bosentan was given alone as a single dose on day 1.
- (See also Effect of Drugs and Other Agents on Cyclosporine Pharmacokinetics and/or Safety) Coadministration of cyclosporine with bosentan should be avoided.
- The effect of cyclosporine on dabigatran concentrations had not been formally studied.
- Concomitant administration of dabigatran and cyclosporine may result in increased plasma dabigatran concentrations due to the P-gp inhibitory activity of cyclosporine.
- Coadministration of cyclosporine with dabigatran should be avoided.
Potassium Sparing Diuretics
- Cyclosporine should not be used with potassium-sparing diuretics because hyperkalemia can occur.
- Caution is also required when cyclosporine is coadministered with potassium-sparing drugs (e.g., angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists), potassium-containing drugs as well as in patients on a potassium-rich diet. Control of potassium levels in these situations is advisable.
Nonsteroidal Anti-inflammatory Drug (NSAID) Interactions
- Clinical status and serum creatinine should be closely monitored when cyclosporine is used with NSAIDs in rheumatoid arthritis patients. (See WARNINGS)
- Pharmacodynamic interactions have been reported to occur between cyclosporine and both naproxen and sulindac, in that concomitant use is associated with additive decreases in renal function, as determined by 99mTc-diethylenetriaminepentaacetic acid (DTPA) and (p-aminohippuric acid) PAH clearances.
- Although concomitant administration of diclofenac does not affect blood concentrations of cyclosporine, it has been associated with approximate doubling of diclofenac blood levels and occasional reports of reversible decreases in renal function.
- Consequently, the dose of diclofenac should be in the lower end of the therapeutic range.
- Preliminary data indicate that when methotrexate and cyclosporine were coadministered to rheumatoid arthritis patients (N=20), methotrexate concentrations (AUCs) were increased approximately 30% and the concentrations (AUCs) of its metabolite, 7-hydroxy methotrexate, were decreased by approximately 80%.
- The clinical significance of this interaction is not known. Cyclosporine concentrations do not appear to have been altered (N=6).
- Elevations in serum creatinine were observed in studies using sirolimus in combination with full-dose cyclosporine.
- This effect is often reversible with cyclosporine dose reduction. Simultaneous coadministration of cyclosporine significantly increases blood levels of sirolimus.
- To minimize increases in sirolimus blood concentrations, it is recommended that sirolimus be given 4 hours after cyclosporine administration.
- Frequent gingival hyperplasia when nifedipine is given concurrently with cyclosporine has been reported.
- The concomitant use of nifedipine should be avoided in patients in whom gingival hyperplasia develops as a side effect of cyclosporine.
- Convulsions when high dose methylprednisolone is given concomitantly with cyclosporine have been reported.
Other Immunosuppressive Drugs and Agents
Psoriasis patients receiving other immunosuppressive agents or radiation therapy (including PUVA and UVB) should not receive concurrent cyclosporine because of the possibility of excessive immunosuppression.
Effect Of Cyclosporine On The Efficacy Of Live Vaccines
- During treatment with cyclosporine, vaccination may be less effective. The use of live vaccines should be avoided.
- For additional information on Cyclosporine Drug Interactions please contact Novartis Medical Affairs Department at 1-888-NOW-NOVA (1-888-669-6682).
Is Sandimmune safe to use while pregnant or breastfeeding?
- There are no adequate and well-controlled studies in pregnant women and therefore, Sandimmune (cyclosporine) should not be used during pregnancy unless the potential benefit to the mother justifies the potential risk to the fetus.
- Cyclosporine is present in breast milk. Because of the potential for serious adverse drug reactions in nursing infants from Sandimmune, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
Sandimmune (cyclosporine) is used with adrenal corticosteroids to prevent organ rejection after a kidney, liver, or heart transplant surgery. Sandimmune is also used to treat people with severe rheumatoid arthritis or severe psoriasis. Side effects of Sandimmune include renal dysfunction, tremor, hirsutism, hypertension, and gum hyperplasia.
Multimedia: Slideshows, Images & Quizzes
What Is Rheumatoid Arthritis (RA)? Symptoms, Treatment, Diagnosis
What is rheumatoid arthritis (RA)? Learn about treatment, diagnosis, and the symptoms of juvenile rheumatoid arthritis. Discover...
Psoriasis Types, Images, Treatments
What is psoriasis? See examples of psoriasis including the different types of nail, plaque, and scalp psoriasis. Learn about...
Rheumatoid Arthritis: Alternative RA Therapies
Learn which alternative treatments show promise for rheumatoid arthritis.
Rheumatoid Arthritis: RA Food Myths and Facts
Is there really an RA diet? Learn the truth from WebMD about which foods can ease your symptoms and which you should avoid.
Rheumatoid Arthritis Exercises: Joint-Friendly Workouts
Regular exercise boosts fitness and helps reverse joint stiffness for people with rheumatoid arthritis (RA). WebMD demonstrates...
RA Home Remedies
People try all sorts of things to relieve rheumatoid arthritis pain. WebMD debunks some of the common ones and lets you know what...
Types of Psoriasis: Medical Pictures and Treatments
Explore the different types of psoriasis such as plaque psoriasis, inverse psoriasis, and scalp psoriasis. Discover what causes...
Picture of Psoriasis Vulgaris Plaque
Psoriasis vulgaris is the most common form of psoriasis. It commonly appears as red, silvery-scaled plaques, as shown here on...
Picture of Psoriasis 2
More than one-quarter of all individuals with psoriasis develop their disease during childhood or adolescence. See a picture of...
Picture of Psoriasis 3
A reddish, scaly rash often located over the surfaces of the elbows, knees, scalp, and around or in the ears, navel, genitals or...
Picture of Psoriasis Vulgaris Soles
Psoriasis vulgaris soles (psoriasis of the feet). Psoriasis on these areas is most likely to show up on the soles but can also...
Picture of Psoriasis Vulgaris Erythematous
Psoriasis Vulgaris Erythematous. Psoriasis Vulgaris Erythematous isa chronic systemic inflammatory disease characterized by...
Picture of Psoriasis Vulgaris
Psoriasis vulgaris is the most common form of psoriasis. A typical manifestation is onycholysis, where the nail separates from...
Picture of Psoriasis Vulgaris Palms
The medical name for the most common form of psoriasis ("vulgaris" means common). About 80% of people with psoriasis have this...
Psoriasis Quiz: Test Your Medical IQ
Take the mystery out of psoriasis. Take the Psoriasis Quiz and see what you know about the types, symptoms, treatments and more.
Rheumatoid Arthritis Quiz: What is Rheumatoid Arthritis?
How is rheumatoid arthritis different from other forms of arthritis, such as osteoarthritis and gout? Take the Rheumatoid...
Picture of Psoriasis 1
A reddish, scaly rash often located over the surfaces of the elbows, knees, scalp, and around or in the ears, navel, genitals or...
Home Remedies for Psoriasis
Discover home remedies for psoriasis and help heal irritated skin.
Picture of Guttate Psoriasis
Guttate psoriasis is a type of psoriasis that looks like small, salmon-pink drops on the skin. See a picture of Guttate Psoriasis...
Picture of Inverse Psoriasis
Inverse psoriasis consists of bright red, smooth (not scaly) patches found in the folds of the skin. See a picture of Inverse...
Picture of Pustular Psoriasis
Pustular psoriasis is an uncommon form of psoriasis. See a picture of Pustular Psoriasis and learn more about the health topic.
Picture of Erythrodermic Psoriasis
This is the least common type of psoriasis and can be quite serious. See a picture of Erythrodermic Psoriasis and learn more...
Picture of Psoriasis of the Scalp
The scalp may have fine, dry, scaly skin or have heavily crusted plaque areas. See a picture of Psoriasis of the Scalp and learn...
Famous Faces With Rheumatoid Arthritis
Learn more about the famous faces of rheumatoid arthritis such as Lucille Ball, Glenn Frey, and more.
Plaque Psoriasis: Top 10 Causes, Triggers and Treatments
Plaque psoriasis triggers a red, scaly rash of plaques on the skin typically affecting the elbows, knees, and scalp. Treatment...
Related Disease Conditions
Rheumatoid Arthritis (RA)
Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Early RA signs and symptoms include anemia, both sides of the body affected (symmetric), depression, fatigue, fever, joint deformity, joint pain, joint redness, joint stiffness, joint swelling, joint tenderness, joint warmth, limping, loss of joint function, loss of joint range of motion, and polyarthritis.
Psoriasis is a long-term skin condition that may cause large plaques of red, raised skin, flakes of dry skin, and skin scales. There are several types of psoriasis, including psoriasis vulgaris, guttate psoriasis, inverse psoriasis, and pustular psoriasis. Symptoms vary depending on the type of psoriasis the patient has. Treatment of psoriasis may include creams, lotions, oral medications, injections and infusions of biologics, and light therapy. There is no cure for psoriasis.
Pain Management and Rheumatoid Arthritis
Second Source article from WebMD
Second Source WebMD Medical Reference
16 Early Rheumatoid Arthritis (RA) Signs & Symptoms
Early rheumatoid arthritis (RA) symptoms and signs vary differently from person to person. The most common body parts that are initially affected by RA include the small joints of the hands, wrists, and feet, and the knees and hip joints. Joint inflammation causes stiffness. Warmth, redness, and pain may vary in degree.
Average Life Expectancy After a Liver Transplant?
Liver transplant (LT) simply means replacing a diseased liver with a healthy one. The new liver may be taken from a brain-dead person (cadaver) or given by a living relative.
Atopic Dermatitis vs Psoriasis
Psoriasis and atopic dermatitis are common, long-term skin diseases. Both are noncontagious. Because both the rashes look somewhat similar, the diagnosis may be difficult at the first glance, and a biopsy of the skin remains the last resort. However, certain things that can help differentiate between the two before the doctor orders a biopsy.
What Disqualifies You for a Liver Transplant?
Because the liver is the only organ in the body that regenerates, or grows back, a transplanted segment of the liver can grow to a normal size within a few months. Liver transplantation is a surgical procedure performed to remove a diseased or injured liver from one person and replace it with a whole or portion of a healthy liver from another person called a donor.
Rheumatoid Arthritis vs. Lupus: Differences and Similarities
Rheumatoid arthritis (RA) and lupus are two varieties of autoimmune diseases that cause flare-ups. While RA attacks the immune system on the joints, lupus involves many other parts of the body besides the joints. Common RA symptoms involve warm, swollen, and painful joints; morning stiffness in the joints or stiffness after inactivity, joint deformity, fever, fatigue, etc. Lupus symptoms include Malar rash (butterfly-shaped rash involving the cheeks and bridge of the nose), fever, joint pain in the absence of joint deformity, etc.
11 Home Remedies for Rheumatoid Arthritis
Rheumatoid arthritis (RA) is a long-term disorder that progressively affects many parts of the body. Home remedies, diet, and lifestyle changes can help reduce pain and discomfort associated with RA alongside medical treatment. Home remedies alone cannot effectively treat RA or prevent the progression of the disease.
How to Get Rid of Psoriasis Quickly
Although psoriasis is incurable, it responds to topical and systemic treatments. Topical treatments that may be effective to treat mild psoriasis include creams, lotions, and sprays.
Scalp Psoriasis (Psoriasis of the Scalp)
Scalp psoriasis causes red, raised, scaly patches that may extend from the scalp to the forehead and the back of the neck and ears. Symptoms and signs include itching, hair loss, flaking, silvery scales, and red plaques. Treatment includes topical medicated shampoos, creams, gels, oils, ointments, and soaps, medications, and light therapy.
Can Rheumatoid Arthritis Be Caused by Stress?
Rheumatoid arthritis can be caused by and result in stress, as well as other conditions such as gastrointestinal problems (IBD).
Rheumatoid Arthritis vs. Fibromyalgia
Though rheumatoid arthritis (RA) and fibromyalgia have similar symptoms, RA is an autoimmune disease and fibromyalgia is a chronic pain syndrome. RA symptoms include joint redness, swelling, and pain that lasts more than 6 weeks. Fibromyalgia symptoms include widespread pain, tingling feet or hands, depression, and bowel irritability. Home remedies for both include stress reduction, exercise, and getting enough sleep.
What Are the Four Stages of Rheumatoid Arthritis?
Rheumatoid arthritis is a chronic inflammatory disease categorized into the following four stages and classifications. Learn the causes, symptoms, and complications of RA below.
Rheumatoid Arthritis vs. Arthritis
Arthritis is a general term used to describe joint disease. Rheumatoid arthritis (RA) is a type of arthritis in which the body’s immune system mistakenly attacks the joints, causing chronic inflammation.
Juvenile Rheumatoid Arthritis (JRA)
Juvenile rheumatoid arthritis (JRA) annually affects one child in every thousand. There are six types of JRA. Treatment of juvenile arthritis depends upon the type the child has and should focus on treating the symptoms that manifest.
How Successful Is a Liver Transplant?
A liver transplant is a surgical procedure performed to remove a damaged or failed liver and replace it with a healthy liver. Liver transplant is usually only performed for severe, end-stage chronic liver disease, which can no longer be treated by other treatment options.
What Is the Main Cause of Psoriasis?
Psoriasis is a non-contagious skin disease in which the skin cells grow in numbers faster than normal, producing rashes on the body. Normally, the cells on the surface of the skin are shed as new cells grow beneath. In psoriasis, the swift build-up of skin cells collects on the surface of the skin as scales or plaques. The exact cause of psoriasis is not completely understood. It appears to involve an interplay between a person’s genes, immune system and environment.
How Serious Is Rheumatoid Arthritis?
Rheumatoid arthritis (RA) is a chronic inflammatory disorder that typically affects the joints and other body parts. If not diagnosed early and appropriately treated, RA can lead to permanent deformities, disabilities, and serious systemic complications.
Is Psoriasis Contagious?
Psoriasis is an incurable skin disease that causes reddish patches of skin topped with a thick layer of dry silvery scales. Psoriasis cannot spread and is not contagious.
Safest Rheumatoid Arthritis Drugs During Pregnancy
None of the drugs used in the treatment of rheumatoid arthritis (RA) is completely safe during pregnancy. You must discuss with your physician regarding the decision to use, modify, or stop any medications.
Breastfeeding With Rheumatoid Arthritis
You can breastfeed your baby even if you have rheumatoid arthritis (RA). However, you must always consult your doctor before you start the process.
Osteoarthritis vs. Rheumatoid Arthritis
Osteoarthritis (OA) and rheumatoid arthritis (RA) are chronic joint disorders. RA is also an autoimmune disease. OA and RA symptoms and signs include joint pain, warmth, and tenderness. Over-the-counter pain relievers treat both diseases. There are several prescription medications that treat RA.
What Is the Difference Between Eczema and Psoriasis?
Allergies and skin reactions trigger eczema. Psoriasis isn't triggered by allergies. Signs and symptoms of eczema include skin redness, swelling, and itching while psoriasis symptoms and signs include thick, red, itchy, and scaly patches of skin.
What Is the Best Treatment for Psoriasis?
Psoriasis is an incurable chronic autoimmune disorder of the skin that causes patches of thick, flaky, scaly skin, mostly around the scalp, knees, and elbows, though any skin surface may be involved. Some people experience only small patches while others have red, inflamed skin and think scaly patches all over the body. The exact cause of psoriasis is not clear, but it isn’t contagious.
How Do You Stop Psoriasis From Stress?
Psoriasis is an autoimmune skin disease that can be passed down (hereditary) to you from your parents or grandparents. Stress is a common factor that can trigger your psoriasis. Psoriasis has a stronger association with psychiatric disorders than other skin diseases. Stress worsens psoriasis by triggering a complex network of signals between the endocrine (hormones), nervous and immune systems.
What Are 5 Common Risk Factors to Rheumatoid Arthritis?
Rheumatoid arthritis (RA) is an autoimmune disorder (the body's immune system mistakenly attacks its own cells). Certain factors increase the risk of RA.
Treatment & Diagnosis
- Rheumatoid Arthritis FAQs
- Psoriasis FAQs
- Will Rheumatoid Arthritis Nodules Go Away?
- What if I get COVID-19 with Rheumatoid Arthritis?
- Is Inflammatory Arthritis the Same as Rheumatoid Arthritis?
- Are Corticosteroids Safe for Pregnant and Nursing Women with Rheumatoid Arthritis?
- How Does Pregnancy Affect the Course of Rheumatoid Arthritis (RA)?
- Psoriasis, Lupus, Rheumatoid Arthritis Share One Gene
- Psoriasis Drugs Strike Immune Targets (Raptiva, Enbrel)
- Can Milk Allergy Cause Rheumatoid Arthritis?
- Can You Get Gout in Your Back?
- What Are the Side Effects of Remicade for Rheumatoid Arthritis?
- Should You Avoid Drinking Soda with Rheumatoid Arthrits?
- Are Hidradenitis and Rheumatoid Arthritis Related?
- How Do You Get Psoriasis?
- Can Psoriasis Be Caused by Allergy?
- Is It Eczema or Psoriasis?
- What Are the Triggers of Psoriasis?
- Does Lipitor Help Rheumatoid Arthritis?
- What's the Rheumatoid Arthritis Prognosis?
- What Are Home Remedies for Rheumatoid Arthritis?
- Psoriasis PUVA Therapy Can Increase Melanoma Risk
Medications & Supplements
- cyclosporine (Restasis)
- Types of Psoriasis Medications
- cyclosporine - oral, Sandimmune
- Types of Rheumatoid Arthritis Medications
- Side Effects of Restasis (cyclosporine ophthalmic emulsion)
- cyclosporine microemulsion capsule - oral, Gengraf, Neoral
- cyclosporine - intravenous, Sandimmune
- cyclosporine microemulsion solution - oral, Gengraf, Neoral
- cyclosporine solution - oral, Sandimmune
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.