DMARDS in the treatment of rheumatoid arthritis

Presentation on Present status of DMARDS in the treatment of RA

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Objective

  • To highlight the present status of disease modifying anti-rheumatic drugs (DMARDs) in the treatment of rheumatoid arthritis

Introduction

  • DMARDs (disease modifying antirheumatic drugs) are drugs which can suppress the rheumatoid process and bring about a remission, but do not have nonspecific anti-inflammatory or analgesic action.

Classification of Anti-rheumatic drugs

A. DMARDs:

  • Immunosuppressants: Methotrexate, Cyclosporine, Azathioprine
  • Sulfasalazine
  • Chloroquine or hydroxychloroquine
  • Leflunomide
  • Gold salts
  • d-Penicillamine

B. Biological response modifiers(BRMs):

  • TNF-α inhibitors: Etanercept, Infliximab
  • IL-1 antagonist: Anakinra

C. Adjuvant drugs

  • Corticosteroids: Prednisolone

Immunosuppressants

Methotrexate:

  • First choice and standard drug for rheumatoid arthritis.
  • Acts by inhibiting an enzyme dihydrofolate reductase
  • Also inhibits other enzyme involve in protein synthesis as well as anti-inflammatory and cytokines modulating effect.
  • Initially low dose(7.5-15 mg/week)
  • Best tolerated among other DMARDs

Adverse drug effects

  1. Nausea and mouth ulcer
  2. Pancytopenia (low blood cells)
  3. Liver cirrhosis
  4. Acute pneumonitis

Contraindications
• Pregnancy
• Lactating mother
• Liver disease
• Leucopenia
• Peptic ulcer

Sulfasalazine

  • It is a compound of sulfapyridine and 5-amino salicyclic acid (5-ASA)
  • Useful in both RA and ulcerative colitis
  • Much more safer than gold salts
  • Second line drugs for milder cases
  • Mode of action is unknown

Adverse drug effects:

  1. Neutropenia, hemolytic anemia
  2. Thrombocytopenia

Gold Salts

  • Water soluble gold preparation like sodium aurothiomalate
  • Gets deposited in the synovial macrophages in actively inflammed joints and inhibits their function.

Adverse drug effects:

  • Dermatitis, nephropathy, bone marrow depression and liver damage.

Etanercept

  • It is a recombinant fusion protein of TNF-receptor and Fc portion of human IgG
  • Reserved for the patients who have failed to respond to adequate trials of atleast two DMARDs

Adverse drug reaction:

  1. Pain, redness, itching, swelling at the infection site
  2. Chest infection may be increasedd-Penicillamine
  3. Splits the rheumatoid factor and also selectively reduces the serum levels of calcium immunoglobin
  4. Adverse drug reactions incidences are high so not commonly used

Gold salts and d-penicillamine should not be combined for the treatment of RA (because of severe ADRs). Gold salts and d-penicillamine are not used in the present context because of severe adverse reactions i.e.

  • Bone marrow depression
  • Kidney and liver damage
  • Ulceration

Presented by Students of KistMCTH 1st year students

  1. Hemu Chaurasia(Roll no-36)
  2. Jemesh Singh Maharjan (Roll no-37)
  3. Jeni Thapa(Roll no-38)
  4. Keshav KC (Roll no-39)
  5. Manisha Bohara (Roll no-40)
  6. Manisha Dhakal (Roll no-41)
  7. Manisha Maharjan (Roll no-42)

Reference

  1. Text book of Pharmacology- K D Tripathi
  2. Text book of Pharmacology- Bennett and Brown

6 Comments
  1. July 3, 2010
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