Drug Therapy of Rheumatoid Arthritis Drugs for Rheumatoid

Drug Therapy of Rheumatoid Arthritis

Drugs for Rheumatoid Arthritis Rheumatoid arthritis (RA) Ø Autoimmune inflammatory disorder Treatment Ø Ø Relieve symptoms Maintain joint function Minimize systemic involvement Delay progression of disease

Classes of Antiarthritic Drugs NSAIDs Ø DMARDs Ø Nonsteroidal anti-inflammatory drugs Disease-modifying antirheumatic drugs Glucocorticoids Ø Adrenal corticosteroids

Drug Selection for Rheumatoid Arthritis Protocol Ø Ø Ø Start with NSAIDs If symptoms persist, add DMARDs Glucocorticoids may be added until DMARDs take effect

DMARDs I: Major Nonbiologic DMARDs Methotrexate Sulfasalazine

Methotrexate Most rapid-acting DMARD Therapeutic effect: 3 to 6 weeks Adverse effects Ø Ø Hepatic fibrosis Bone marrow suppression GI ulceration Pneumonitis

Sulfasalazine Used to treat inflammatory bowel disease (IBD); now used for RA as well Ø Ø Ø Anti-inflammatory and immunomodulatory actions Can slow progression of joint deterioration GI side effects may be intolerable

Other DMARDs I: Major Nonbiologic DMARDs Leflunomid (Arava) Hydroxychloroquine (Plaquenil)

DMARDs II: Major Biologic DMARDs Tumor necrosis factor inhibitors Ø Ø Ø Suppress immune function Pose risk of serious infection Work by neutralizing tumor necrosis factor (TNF) • Etanercept (Enbrel) • Infliximab (Remicade) • Adalimumab (Humira)

Etanercept New DMARD Ø Use Ø Inactivates TNF Moderate to severe RA Adverse effects Ø Ø Ø Infection (may be serious) Injection-site reactions Tuberculosis Heart failure Cancer Other adverse effects