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Summary Rheumatoid arthritis treatment summarise

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  • June 19, 2019
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  • 2014/2015
  • Summary
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Goal of treatment:
 Achieve the lowest possible arthritis disease activity & remission (if possible)
 Minimize joint damage
 Enhance physical function & quality of life
 Suppress inflammation
 Correct mechanical and structural abnormalities

Traditional disease modifying anti-rheumatic drugs
1. Methotrexate
2. Azathioprine (Imuran)
3. Cyclosporine (Neoral)
4. Sulfasalazine (Salazopyrin)
5. Chloroquine (Nivaquine)
6. Leflunomide (Azara)
7. Gold salts

, Drug name General PK MoA SEs CI

Drug name General PK MoA SEs CI
Methotrexat  Mainstay in severe  Orally 1. Anti-inflammatory  Mucosal  Alcohol use
severe RA (psoriatic) OR  Interrupts ulceration and  Liver/lung
e
Sulfasalazin not responding to  IM adenosine pathway
 Unknown  nausea
Allergic disease
NSAIDS  Rapid OoA  Possible effects on  Cytopenias (wbc
reactions (Sulfa)
e  Alone or combined  Benefits in 2- TNF pathways  count)
Mild GI
 Pregnancy
 Myelosuppresion
(Salazopyrin  Best 3 weeks 2. Immunosuppressive  Liver cirrhosis
complaints
 Relatively and toxic effects  Interstitial
) inexpensive  Due to (-) of folic
 Mild cytopenias
pneumositis
(↓ no.
 Generally safe acid metabolizing  Alopecia
bloodcells)
enzyme  “Methotrexate
 Hepatotoxicity
Chloroquine  Antimalarial drug 3. Inhibits:
 Unknown fog”
 NB toxicities on
 Relatively safe  Lymphocyte Birth
 the defects
eye
(Nivaquine)  Well tolerated proliferation  Ophthalmological
 Limited to prevent  Production of NB examination
regular @
joint damage on its cytokines & bloodwork
baseline and 6-12
own rheumatoid factors ↓SEs with Folic acid
months
 Use for mild, non- 4. Interferes with: thereafter
erosive disease  Polymorphonuclear
leukocyte
Leflunomide  Similar efficacy to  Well  ↓ chemotaxis
pain and  Headache,  Pregnancy
Methotrexate absorbed 5. inflammation
↓ cytotoxins and free diarrhea and  Women of
(Arava)  Alternative to after p.o. radical production
 SLOWS progression(↓of nausea child-bearing
Methotrexate  > 90% bound damage todamage
structural synovial  Other: ↓ potential
intolerant patients to albumin membrane and bone) weight, allergic  TERATOGENI
Azothioprine Precautions:
Monotherapy or  T8-12
 1/2 = weeks
14-18  Loss of appetite
reactions (flu- C
Liver & renal
 combined with for effect
days (LONG =  Liver problems
like syndrome), In
(Imuran) problems
Methotrexate NB LOADING  Nausea,
skin rash,vomiting experimental
 Allopurinol/ACE-(-) DOSES)  Extreme
alopecia,fatigue
and animals
patients  Rapidly hypokalemia
concerted to
Cyclosporine  IMMUNOSUPPRESIV the (+)  High BP
E drug metabolite  Renal
(Neoral)  Excreted in insufficiency
the urine &  Infection
the feces  Hirsutism
 Metabolite
undergoes
biliary
recycling

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