Disease Modifying Anti-Rheumatic Drugs Sample Clauses

Disease Modifying Anti-Rheumatic Drugs. (DMARDs) DMARDs are a group of unrelated drugs which are defined by their use in RA to slow disease progression. These drugs are distinct from anti-inflammatories which simply reduce inflammation without having an effect on the course of disease. Although these drugs were first used in RA there use has become much more widespread and they are used in other inflammatory conditions including other types of inflammatory arthritis as well as connective disease diseases and inflammatory bowel disease. It is not clear how some of the drugs used in RA exert their effect and in fact only two DMARDs were developed specifically for RA; oral auranofin (no longer used) and leflunomide. A list of current DMARDs and their mechanisms of action are listed in Table 1.5. Table 1:5 DMARDS and Their Mechanisms of Action DMARD Proposed Mechanism Azathioprine Purine synthesis inhibitor Ciclosporin Inhibits calcineurin and reduces T lymphocytes D-Penicillamine Unclear but felt it inhibits proliferation of T lymphocytes Gold Salts Felt to be similar to D-penicillamine Hydroxychloroquine Interference with antigen processing Leflunomide Methotrexate Pyrimidine synthesis inhibitor (dihydroorotate dehydrogenase inhibitor) Inhibits metabolism of folic acid (dihydrofolate reductase inhibitor) Sulfasalazine Possible Inhibitor of NF-kappaB All DMARDs have side effects some of which are fairly minor such as nausea and diarrhoea but many can have potentially serious side effects requiring regular monitoring of patients receiving such drugs. These side effects include bone marrow suppression, hepatitis and rarely fulminant liver failure, hypertension, pneumonitis and an increased risk of infection. Methotrexate is now probably the most widely used DMARD in RA. It can be used as monotherapy as well as in various combinations. When new studies are designed for new drug treatments in RA, methotrexate is used as standard therapy and in the trials of new biologic therapies, methotrexate is usually trialled in combination with any new drug. DMARDs are now used early in disease and there is good evidence that combinations of DMARDs are better from the outset than monotherapy DMARDs. [Xxxxxxxxx et al. 1998] Common combinations include so called ‘triple therapy’; methotrexate, sulfasalazine and hydroxychloroquine [O’Dell et al. 1996] as well as ciclosporin and methotrexate. [Xxxx et al. 2008] Those patients who fail to respond to good doses of combination therapies should be considered for biologic ...
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