ANTI-RHEUMATOID DRUGS & THER GOALS AND SIDE EFFECT

ANTI-RHEUMATOID DRUGS & THER GOALS AND SIDE EFFECT

These are drugs which (except corticosteroids), can suppress the rheumatoid process, bring about a remission and retard disease progression, but do not have nonspecific anti-inflammatory or analgesic action. They are used in rheumatoid arthritis (RA) in addition to NSAIDs and are also referred to as disease modifying antirheumatic drugs (DMARDs) or slow acting antirheumatic drugs (SAARDs).

Rheumatoid arthritis (RA) is an autoimmune disease in which there is joint inflammation, synovial proliferation and destruction of articular cartilage. Immune complexes composed of IgM activate complement and release cytokines (mainly TNFα and IL-1) which are chemotactic for neutrophils. These inflammatory cells secrete lysosomal enzymes which damage cartilage and erode bone, while PGs produced in the process cause vasodilatation and pain. RA is a chronic progressive, crippling disorder with a waxing and waning course. NSAIDs are the first line drugs and afford symptomatic relief in pain, swelling, morning stiffness, immobility

CLASSIFICATION

I. Disease modifying antirheumatic drugs (DMARDs)

A. Nonbiological drugs

1. Immunosuppressants: Methotrexate, Azathioprine, Cyclosporine

2. Sulfasalazine

3. Chloroquine or Hydroxychloroquine

4. Leflunomide

B. Biological agents

1. TNFα inhibitors: Etanercept, Infliximab, Adalimumab

2. IL-1 antagonist: Anakinra

II. Adjuvant drugs

Corticosteroids: Prednisolone and others

The goals of drug therapy in RA are:

• Ameliorate pain, swelling and joint stiffness

• Prevent articular cartilage damage and bony erosions

• Prevent deformity and preserve joint function. In some mild/early cases are mainly treated with NSAIDs drugs only, the current recommendation is to add DMARDs as soon as the diagnosis of RA is confirmed. However, use of DMARDs in early/mild RA should be weighed against their potential adverse effects, which may be serious. More than one DMARD may be used concurrently; advanced cases may require 2 or 3 drugs together, because all DMARDs tend to lose effectiveness with time.

Side effects-

Stomach Upset, Diarrhea, Nausea - The most common side effect of methotrexate is stomach upset, especially it make Diarrhea.

Infection Risk - DMARDs work by suppressing your over-active immune system. This can put you at increased risk for a variety of infections. Biologic agents, such as TNF inhibitors, are even more associated with increased risk of infection.

Hair Loss - Both methotrexate and leflunomide can cause hair loss.

Fatigue - Another common side effect of DMARDs is fatigue. You may feel winded or tired, most commonly with methotrexate.

Liver Damage - Some DMARDs can cause liver damage.