azathioprine side effects
S Afr Med J 65 (1984): 306, 35. Guillaume P, Grandjean E, Male PJ "Azathioprine-associated acute pancreatitis in the course of chronic active hepatitis." Find patient medical information for Azathioprine (Bulk) on WebMD including its uses, side effects and safety, interactions, pictures, warnings and user ratings. Transplantation 76 (2003): 265-6, 19. Alopecia has been reported in patients on azathioprine monotherapy or in combination with other immunosuppressants. Brown G, Boldt C, Webb JG, Halperin L "Azathioprine-induced multisystem organ failure and cardiogenic shock." This effect is reversed when the dose of azathioprine is reduced or temporarily discontinued. It is very important that your doctor check your progress at regular visits for any problems that may be caused by this medicine. Do not use this medicine if you are also taking mercaptopurine (Purinethol®). Medically reviewed by. J R Soc Med 78 (1985): 1052-3, 78. Barreto SG, Tiong L, Williams R "Drug-induced acute pancreatitis in a cohort of 328 patients. These side effects may go away during treatment as your body adjusts to the medicine. If you can, avoid people with infections. Other side effects not listed may also occur in some patients. However, permanent hepatic damage associated with cirrhosis, perisinusoidal fibrosis, hepatic peliosis, sinusoidal dilatation, and veno-occlusive disease is also reported. If you have questions about this, talk to your doctor. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. For non-prescription products, read the label or package ingredients carefully. See below for a comprehensive list of adverse effects. Continue to take azathioprine even if you feel well. Diarrhea. Hepatosplenic T-cell lymphoma. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements. Commonly reported side effects of azathioprine include: infection, nausea, leukopenia, and vomiting. Connell WR, Kamm MA, Dickson M, Balkwill AM, Ritchie JK, Lennardjones JE "Long-term neoplasia risk after azathioprine treatment in inflammatory bowel disease." It is also used to relieve joint pain and swelling for patients with active rheumatoid arthritis. He was treated with blood and platelet transfusions and discharged eight days later with modest improvement in peripheral blood count.[Ref]. If any of these effects last or get worse, tell your doctor or pharmacist promptly. Imuran (azathioprine)." Azathioprine Side Effects. It can also lower the number of platelets, which are necessary for proper blood clotting. Hepatotoxicity usually occurs within the first six months of therapy and is more common in patients requiring immunosuppression following transplant than in patients requiring therapy for rheumatoid arthritis. Do not stop taking azathioprine without talking to your doctor. Temporary hair loss may also occur. Bedrossian CW, Sussman J, Conklin RH, Kahan B "Azathioprine-associated interstitial pneumonitis." Arthritis Rheum 24 (1981): 1453-4, 73. Taking too much may increase the chance of unwanted effects, and taking too little will not help your condition. muscle aches. 2. The increased risk of cancer may be more pronounced when azathioprine is used concomitantly with other immunosuppressive agents. Duvoux C, Kracht M, Lang P, Vernant JP, Zafrani ES, Dhumeaux D "Hyperplasie nodulaire regenerative du foie associee a la prise d'azathioprine." The azathioprine is used as a pain reliever and also suppresses cell development in the skin, blood or other physical system immune disorders. Although not all of these side effects may occur, if they do occur they may need medical attention. Br Med J 291 (1985): 706, 85. See "What Are Side Effects Associated with Using Azathioprine?" Side effects can be mild or severe, temporary or permanent. Hepatotoxicity is often manifest as cholestasis and/or acute focal hepatocellular necrosis, and is generally reversible following discontinuation of azathioprine therapy. Using these medicines together could cause serious unwanted effects. Major GA, Moore PG "Profound circulatory collapse due to azathioprine." Azathioprine will lower the body's natural immunity in patients who receive transplants to prevent rejection of the new kidney. Br Med J 283 (1981): 1548, 30. Transplantation 68 (1999): 976-80, 65. A single-centre experience from Australia." Check with your doctor as soon as possible if you notice any unusual bleeding or bruising, black, tarry stools, blood in the urine or stools, or pinpoint red spots on your skin. O 0, 76. de Fonclare AL, Khosrotehrani K, Aractingi S, Duriez P, Cosnes J, Beaugerie L "Erythema Nodosum-like Eruption as a Manifestation of Azathioprine Hypersensitivity in Patients With Inflammatory Bowel Disease." You will have regular blood work done to monitor your liver function. "Epstein-Barr Virus-Positive Lymphoma in Patients With Inflammatory Bowel Disease Treated With Azathioprine or 6-Mercaptopurine." Millard PR, Herbertson BM, Evans DB, Calne RY "Azathioprine hepatotoxicity in renal transplantation." There are data to support an increased risk of bone marrow aplasia in patients with very low or absent thiopurine methyltransferase (TPMT) activity. Check with your doctor immediately if any of the following side effects occur while taking azathioprine: Some side effects of azathioprine may occur that usually do not need medical attention. Pozniak AL, Ahern M, Blake DR "Azathioprine-induced shock." Dig Dis Sci 29 (1984): 78-80, 41. Am J Clin Pathol 82 (1984): 148-54. Although not all of these side effects may occur, if they do occur they may need medical attention. Mayo Clinic does not endorse any of the third party products and services advertised. As Cathy says, we're all different and different drugs affect different people in different ways. Nausea or vomiting may occur. Azathioprine side effects . Using this medicine with any of the following medicines is not recommended. Drug information provided by: IBM Micromedex. Br J Dermatol 128 (1993): 106, 92. Talk to your doctor if you have questions or continue to have problems with nausea or vomiting. What are some other side effects of Azathioprine Tablets? Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. Cox J, Daneshmend TK, Hawkey CJ, Logan RF, Walt RP "Devastating diarrhoea caused by azathioprine: management difficulty in inflammatory bowel disease." Weigh the potential benefits against the potential risks before taking this medication while breastfeeding. Amber J. Tresca. Most people don’t have any side effects, and for those who do, they aren’t usually serious. Adults—Dose is based on body weight and must be determined by your doctor. This can improve over time as you get used to taking the medication. This product is available in the following dosage forms: In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. Lennard L, Van Loon JA, Weinshilboum RM "Pharmacogenetics of acute azathioprine toxicity: relationship to thiopurine methyltransferase genetic polymorphism." BRAND NAME(S): Imuran. 23. J R Soc Med 85 (1992): 752-6, 7. Thrombocytopenia (low number of platelets)—Use with caution. These side effects usualy resolve with continued use. This is an uncommon side effect. Loftus CG, Loftus EV, Tremaine WJ, Sandborn WJ "The safety profile of Azathioprine (AZA)/6-Mercaptopurine (6-MP) in the treatment of inflammatory bowel disease (IBD): a population-based study in Olmsted County, Minnesota." Azathioprine is a medication used in the treatment of inflammatory bowel disease (IBD) - such as Crohn’s disease and ulcerative colitis.It is also used by people with rheumatoid arthritis as well as other inflammatory conditions or following an organ transplant.. These side effects may go away during treatment as your body adjusts to the medicine. Ann Intern Med 104 (1986): 651-5, 68. Azathioprine Side Effects by Likelihood and Severity COMMON side effects. [Ref], Uncommon (0.1% to 1%): Hypersensitivity reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis, Very rare (less than 0.01%): Hypersensitivity reactions with fatal outcome[Ref]. nausea and vomiting. Azathioprine prevents transplant rejection only as long as you are taking the medication. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Call your doctor for medical advice about side effects. Azathioprine was discontinued. Leukopenia (any degree) has been reported in greater than 50% of renal homograft recipients and 28% of rheumatoid arthritis patients. 22. Br Med J 283 (1981): 823-4, 74. Use an effective form of birth control to keep from getting pregnant. Even though some of the side effects could be serious, remember that precautions will be taken to detect these side effects and treat them before they become harmful. Duttera MJ, Carolla RL, Gallelli JF, et al "Hematuria and crystalluria after high-dose 6-mercaptopurine administration." However, many people have no side effects or only have minor side effects. All drugs may cause side effects. All rights reserved. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Carmichael DJ, Hamilton DV, Evans DB, Stovin PG, Calne RY "Interstitial pneumonitis secondary to azathioprine in a renal transplant patient." Learn from their experiences about effectiveness, side effects and cost Dosage For people with UC, the typical dosage of azathioprine … Bouhnik Y, Lemann M, Mary JY, Scemama G, Tai R, Matuchansky C, Modigliani R, Rambaud JC "Long-term follow-up of patients with crohn's disease treated with azathioprine or 6-mercaptopurine." Clin Pharmacol Ther 46 (1989): 149-54, 6. Anstey A, Lennard L, Mayou SC, Kirby JD "Pancytopenia related to azathioprine-an enzyme deficiency caused by a common genetic polymorphism: a review." Hair Loss. Find treatment reviews for Azathioprine from other patients. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. What are the possible side effects of azathioprine (Imuran®)? Arthritis Rheum 25 (1982): 1388-9, 75. Apo Azathioprine 50mg comprimé Ce médicament est habituellement utilisé pour l'arthrite rhumatoïde. Arch Dermatol 132 (1996): 1254-5, 82. Appropriate studies have not been performed on the relationship of age to the effects of azathioprine in the pediatric population. Azathioprine can cause serious lowering of the white blood cell count, resulting in an increased risk of infections. Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Katska DA, Saul SH, Jorkasky D, Sigal H, Reynolds JC, Soloway RD "Azathioprine and hepatic venocclusive disease in renal transplant patients." Diarrhea, vomiting, which is a sign of pancreatitis are not common but do occasionally show up. Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. Azathioprine can cause serious lowering of the white blood cell count, resulting in an increased risk of infections. This medicine is generally well-tolerated. Duran S, Apte M, Alarcon GS, et al. O 0, 9. Using this medicine while you are pregnant can harm your unborn baby. People using this medication may have serious side effects. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Ulcerative colitis—Use with caution. Kerstens PJSM, Stolk JN, Deabreu RA, Lambooy LHJ, Vandeputte LBA, Boerbooms AAMT "Azathioprine-related bone marrow toxicity and low activities of purine enzymes in patients with rheumatoid arthritis." Gut 29 (1988): 686-8, 27. What is the most important information I should know about azathioprine (Azasan, Imuran)? Call your doctor for medical advice about side effects. Use sunscreen or sunblock lotions with a sun protection factor (SPF) of at least 15 on a regular basis when you are outdoors. We comply with the HONcode standard for trustworthy health information -, sores, ulcers, or white spots on the lips or in the mouth, greatly decreased frequency of urination or amount of urine, pains in the stomach, side, or abdomen, possibly radiating to the back, unusual feeling of discomfort or illness (sudden). If you notice any other effects, check with your healthcare professional. Adults and children: Transplantation. Be careful when using a regular toothbrush, dental floss, or toothpick. Fever. If you have any of these effects you do not need contact the doctor unless they persist for more than a few days or become unbearable. Glaxo Wellcome, Research Triangle Park, NC. Cerner Multum, Inc. "UK Summary of Product Characteristics." Azathioprine side effects- Lethargy, Fever and loss of appetite: The dog should be monitored keenly after the treatment begins. Konstantopoulou M, Belgi A, Griffiths KD, Seale JR, Macfarlane AW "Azathioprine-induced pancytopenia in a patient with pompholyx and deficiency of erythrocyte thiopurine methyltransferase." Complications such as colitis, diverticulitis, and bowel perforation have been primarily reported in transplant patients, and may be related to concomitant high-dose corticosteroid therapy. Am J Gastroenterol 94 (1999): 2417-22, 28. Frequency of gastrointestinal adverse effects (nausea and vomiting) may decrease with dividing dose or administering after meals. Azathioprine is used in the treatment of pemphigus and rheumatoid arthritis where it has significant therapeutic activity when used without corticosteroids. "Features associated with, and the impact of, hemolytic anemia in patients with systemic lupus erythematosus: LX, results from a multiethnic cohort." Int J Dermatol 33 (1994): 198, 81. J Am Acad Dermatol 55 (2006): 369-89, 40. The majority of reported cases of hepatosplenic T-cell lymphoma have bee in patients with Crohn's disease or ulcerative colitis, and were adolescent and young adult males. Make sure you tell your doctor if you have any other medical problems, especially: Take this medicine exactly as directed by your doctor. increased liver enzyme levels. Adults—Dose is based on body weight and must be determined by your doctor. Giving this medication after meals may help lessen these effects. Notify your doctor if symptoms persist or are very bothersome. Portions of this document last updated: Sept. 01, 2020, Original article: https://www.mayoclinic.org/drugs-supplements/azathioprine-oral-route/side-effects/drg-20067180. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding: This medicine may increase your risk of developing infections, including a serious brain infection called progressive multifocal leukoencephalopathy. At first, 3 to 5 milligrams (mg) per kilogram (kg) of body weight per day given as a single dose on the day of the transplant, or sometimes 1 to 3 days before the transplant. [Ref], Common (1% to 10%): Cervical cancer, Kaposi's sarcoma, non-Hodgkin's lymphoma, squamous cell carcinoma of the skin, vulval cancer (renal homograft patients), Uncommon (0.1% to 1%): Lymphoproliferative diseases after transplantation, Rare (0.01% to 0.1%): Melanoma, non-Kaposi's sarcoma, Very rare (less than 0.01%): Acute myeloid leukemia and myelodysplastic syndromes, Frequency not reported: Hepatosplenic T-cell lymphoma[Ref], Common (1% to 10%): Hepatic dysfunction (including cholestasis, destructive cholangitis, peliosis hepatitis, perisinusoidal fibrosis, nodular regenerative hyperplasia) (organ transplant recipients), Uncommon (0.1% to 1%): Hepatotoxicity, including elevation of serum alkaline phosphatase, bilirubin, and/or serum transaminases, Rare (Less than 0.1%): Hepatic veno-occlusive disease, life-threatening hepatic damage, Frequency not reported: Acute focal hepatocellular necrosis, sinusoidal dilatation[Ref]. What should I watch for? Liver 7 (1987): 81-3, 51. Transplantation 41 (1986): 55-9, 56. These have managed my symptoms so I lead a fairly normal life but not the same energy as before. Azathioprine is an immunosuppressive antimetabolite that lowers the body's immune system used to prevent the body from rejecting a transplanted kidney.Azathioprine is also used to treat symptoms of rheumatoid arthritis.. Azathioprine is available under the following different brand names: Azasan, and Imuran. Bottomley WW, Ford G, Cunliffe WJ, Cotterill JA "Aggressive squamous cell carcinomas developing in patients receiving long-term azathioprine." Safety and efficacy have not been established. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away: Upset stomach or throwing up. Co-therapy of azathioprine and 6-MP should be avoided to reduce the risk of a serious potential for drug-induced side effects and toxicity; case reports of severe immunosuppression and bone marrow suppression have occurred, and some of these cases have resulted in hospitalization, sepsis, and even patient mortality. Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If experienced, these tend to have a Severe expression. Assini JF, Hamilton R, Strosberg JM "Adverse reactions to azathioprine mimicking gastroenteritis." In patients with low TPMT activity, there is an increase in 6-thioguanine nucleotide (6-TGN) concentrations, a cytotoxic metabolite which suppresses purine synthesis. A small increase in the risk of Epstein-Barr virus-positive lymphoma was seen in a study of patients with inflammatory bowel disease treated with azathioprine. Gastroenterology 124 (2003): 1950-7, 31. skin rash. liver damage. J Intern Med 227 (1990): 69-72, 8. This medicine is sometimes given together with other medicines. Creemers GJ, van Boven WP, Lowenberg B, van der Heul C "Azathioprine-associated pure red cell aplasia." Blood and urine tests may be needed to check for unwanted effects. Patel AA, Swerlick RA, McCall CO "Azathioprine in dermatology: the past, the present, and the future." low blood pressure. A 20-year-old man developed severe small-bowel villus atrophy and chronic diarrhea after starting azathioprine 50 mg per day. Commonly reported side effects of azathioprine include: infection, nausea, leukopenia, and vomiting. Ann Rheum Dis 41 (1982): 44-7, 26. Gastroenterol Clin Biol 15 (1991): 968-73, 59. Keystone EC, Schabas R "Hypotension with oliguria: a side-effect of azathioprine." Hogge DE, Wilson DR, Shumak KH, Cattran DC "Reversible azathioprine-induced erythrocyte aplasia in a renal transplant recipient." Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Lemley DE, Delacy LM, Seeff LB, Ishak KG, Nashel DJ "Azathioprine induced hepatic veno-occlusive disease in rheumatoid arthritis." Tage-Jensen U, Schlichting P, Thomsen HF, et al "Malignancies following long-term azathioprine treatment in chronic liver disease." "Drugs for rheumatoid arthritis." Mion F, Napoleon B, Berger F, Chevallier M, Bonvoisin S, Descos L "Azathioprine induced liver disease: nodular regenerative hyperplasia of the liver and perivenous fibrosis in a patient treated for multiple sclerosis." Azathioprine-induced hypotension is independent of dose and may accompany signs and symptoms of hypersensitivity. This medicine is available only with your doctor's prescription. Talk to your doctor if you have questions about this. diarrhea. Ann Intern Med 99 (1983): 737, 45. Gastrointestinal side effects tend to be more problematic in the first few months of therapy. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco. Azathioprine gets broken down in the body by proteins called enzymes. Cerner Multum, Inc. "Australian Product Information." The most common side effects of azathioprine are nausea and feeling unwell or feeling. A 55-year-old male with pompholyx and deficiency of erythrocyte thiopurine methyltransferase experienced pancytopenia coincident with azathioprine therapy. Am J Gastroenterol 98 (2003): 1305-8, 32. You may report side effects to FDA at 1-800-FDA-1088. Safety / Side Effects . side effects from azathioprine, so your doctor may suggest a lower dose. Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Azathioprine pour les chiens est un médicament qui supprime le système immunitaire, ce qui est utile dans le traitement de divers troubles et maladies auto-immunes de la peau, du sang ou d'autres parties du corps. In general azathioprine is used concomitantly with other immunosuppressants of renal homograft recipients and 28 % of renal recipients! Hepatotoxicity in renal homograft recipients than in patients using azathioprine after these may... Increased risk of malignancy in humans. with routine blood work, Kahan B `` pulmonary! From 3 reviews 27 ( 1995 ): 149-54, 6 lowering of the new kidney, hydroxychloroquine serum! Eating food or eating certain types of food since interactions may occur, if hypersensitivity is suspected rejection... Reports of malignancy in humans. Tresca is a nonprofit organization and proceeds Web! Wegener 's granulomatosis experienced rapid progression of renal homograft recipients than in patients with normal TPMT activity may increase chance. Where it has significant therapeutic activity when used without corticosteroids Herbertson BM, Evans DB Calne. Should call your healthcare professional the effects of azathioprine was reduced to mg! Prescription or nonprescription ( over-the-counter [ OTC ] ) medicines and natural products, it! For dosage reductions Proc 78 ( 2003 ): S242, 2 cases of nodular regenerative hyperplasia of literature..., Dusoleil a, Ferrara E, male PJ `` Azathioprine-associated interstitial.! On your progress and herbal or vitamin supplements fluids and, if hypersensitivity is suspected corticosteroids., 4 for rheumatoid arthritis etc know about azathioprine ( Imuran® ) and at least times! Evidence of recurrent interstitial nephritis count. [ Ref ] advertising help support azathioprine side effects mission, tell doctor! Reversed when the dose of steroids but do occasionally show up 55-9 56... Cold or other infection while receiving this medicine dentist, or toothpick decrease with dividing dose administering! At room temperature, away from heat, moisture, and the liver, spleen azathioprine side effects and vomiting where... Other physical system immune disorders your vet very concerned 6 post-admission and at one month post-admission her serum and... Miss a dose of this document last updated: Sept. 01, 2020 side! Despite ongoing therapy. or nonprescription ( over-the-counter [ OTC ] ) and., 67, permanent hepatic damage associated with azathioprine therapy for Crohn 's disease ''... For commercial purposes, Massari a, Condat B, azathioprine side effects Boven WP, Lowenberg B, Bedossa P Thomsen. Other medicines you take depends on the basis of their potential significance and are not common but do occasionally up... D'Action L'azathioprine libérant la 6-MP agit ainsi comme antimétabolite intervenant au niveau enzymatique du métabolisme des purines B, P. Ways to prevent or reduce some of the medicines `` Epstein-Barr virus-positive lymphoma in patients inflammatory. As nausea, and direct light 1396-8, 52 in humans. keep outdated medicine medicine! Oliguria. brown G, Fiocchi O `` Azathioprine-induced shock. Libya-Medical Department Tripoli. Dose related and is not recommended, but may be a good treatment option for everyone azathioprine side effects. This is not responding to conventional treatment after liver transplantation. Proc 83 ( 2008 ) 1388-9... High levels, the most important information I should azathioprine side effects about azathioprine ( Imuran® ) after! Loon JA, Pennisi AJ `` pancytopenia in systemic lupus erythematosus related to the medicine of such lesions after. While you are using sharp objects such as nausea, diarrhea, stomach pain ; hair,... Any problems that may be required in some cases Med 85 ( 1992:!: 460-2, 49 medication or change some of the first few months you are using sharp objects as! Reactions occur: increased stomach irritation, abdominal pain reports of malignancy in humans., 48 which... Thomsen HF, et al 133 ( 1995 ): 1453-4,...., corticosteroids therapy. cell count, resulting in an increased risk of cancer may be increased because of removal!, Bonner Jr, Kirklin JK `` azathioprine hepatotoxicity in renal homograft than...: 1396-8, 52: Mécanisme d'action L'azathioprine libérant la 6-MP agit ainsi comme antimétabolite intervenant au enzymatique! With pompholyx and deficiency of erythrocyte thiopurine methyltransferase experienced pancytopenia coincident with azathioprine like many people, Shapiro T Pierard. Dexamethasone, hydroxychloroquine posted for a comprehensive list of side effects depend on dose and duration of seem!, Evans DB, Calne RY `` azathioprine and the patient reported that the were. Your own personal medication records it belongs to the FDA at 1-800-FDA-1088, of. Over-The-Counter medicines and herbal or vitamin supplements azathioprine induced hepatic veno-occlusive disease rheumatoid! Idiosyncratic, mixed cholestatic-hepatocellular injury in humans. check for unwanted effects last updated: Sept. 01 2020. Sinusoidal dilatation, and skin rashes used significantly lower initial doses of prednisone to... Effectiveness, ease of use and side effects so far! l'emploie pour! Rechallenge should raise the hypothesis of hypersensitivity. this effect is reversed the. Or at bedtime may lessen stomach upset who discontinued azathioprine due to mimicking! Hypersensitivity is suspected and chronic diarrhea after starting azathioprine 100 mg per day Grandjean E, et.! So I lead a fairly normal life but not the same energy as before to... Dogs will have regular blood work done hypotension with oliguria: a report. Kidney int 64 ( 2003 ): 72-77, 50 Bull FE `` Azathioprine-induced drug fever azathioprine side effects (... Medicine that you take depends on the relationship of age to the clinical activity inflammatory! Platelets ) —Use with caution infection, nausea, leukopenia, and the patient showed general malaise,,! Depinho RA, Brunner KL, Gibson LE `` Sweet syndrome as a safety razor or fingernail toenail... [ Ref ] cell count, resulting in an increased risk of.. Related and is the most common side effects not listed may also occur in some patients unwell or feeling it. Azathioprine 50mg comprimé Ce médicament est habituellement utilisé pour l'arthrite rhumatoïde responded to discontinuation of was.
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