DMARDs

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DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARDs)

3-BIOLOGIC THERAPIES IN RHEUMATOID ARTHRITIS

Anakinra

IL-1 receptor antagonist

Tofacitinib

METABOLISUM by CYP3A4

inhibitor of Janus kinases

Tocilizumab

blocking the IL-6 receptor

Rituximab

B-cell depletion

Abatacept

preventing full T-cell activation

Adalimumab, Certolizumab, Etanercept, Golimumab, Infliximab

Infliximab is not indicated for monotherapy

moderate to severe RA, psoriatic arthritis, ankylosing spondylitis, and Crohn's disease

They interfere with the binding of TNF- α to its receptor

IL-1 and TNF- α are pro-inflammatory cytokines involved in the pathogenesis of RA

1-Choice of drug

Most of these agents are contraindicated for use in pregnant women.

For patients with more established disease, use of other biologic therapies is considered

Monotherapy may be initiated with any of the DMARDs

sulfasalazine

hydroxychloroquine

leflunomide

methotrexate

A trial of several different drugs may be necessary

No one DMARD is efficacious and safe in every patient

2-drugs

Glucocorticoids

Sulfasalazine

associated with leukopenia

combination with methotrexate and/or hydroxychloroquine.

early, mild RA

Minocycline

not utilized as first-line therapy

Leflunomideopic

not recommended in patients with liver disease

SE.

hypokalemia and nausea

alopecia

skin rash

a flu-like syndrome

allergic reactions

weight loss

diarrhea

headache

used as monotherapy or in combination with methotrexate

inhibitory action on dihydroorotate dehydrogenase so inhibit DNA

immunomodulatory agent

Hydroxychloroquine

Hydroxychloroquine has less effects on the liver and immune system than other

response 6 weeks to 6 months

unknown mechanisium

Methotrexate

S.E

acute pneumonia-like syndrome

cirrhosis of the liver

mucosal ulceration and nausea

Doses need for RA is less than in cancer

Response 3 to 6 weeks

immunosuppressive and anti-inflammatory effects

Methotrexate is a folic acid antagonist

treatment in patients with rheumatoid or psoriatic arthritis