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Adverse Drug Reactions (ADRs), such as arthralgia, may occur from the Drug-resistant TB (DR-TB) treatment regimen.
Suspected agent(s): Pyrazinamide (Z), Fluoroquinolone (FQ), Bedaquiline (Bdq)
Suggested Management Strategies
- Initiate with paracetamol in the beginning.
- Treatment with non-steroidal anti-inflammatory drugs (Indomethacin 50 mg twice daily or Ibuprofen 400 to 800 mg three times a day).
- Lower the dose of the suspected agent (most commonly Z) if this can be done without compromising the regimen.
- Discontinue the suspected agent if this can be done without compromising the regimen.
Points to Note
- Symptoms of arthralgia generally diminish over time, even without intervention.
- Uric acid levels may be elevated in patients on Z.
- There is little evidence to support the addition of Allopurinol for arthralgia. However, if gout is present, it should be used.
- If acute swelling, redness, and warmth are present in a joint, consider aspiration for diagnosis of gout, infections, autoimmune diseases, etc.
Resources
- Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, March 2021.
- Ready Reckoner for Medical Officer - Adverse Drug Reactions Associated with Anti-TB Drugs Identification and Management, 2019.
- Technical and Operational Guidelines for TB in India, 2016.
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