Drugs used in treatment of rheumatoid arthritis
Drugs affects TNF
-TNF is a major acute phase reactant that takes part in inflammation and immune responses 1) entanercept; - recombinant form of TNF receptor -the endogenous TNF binds to entanercept instead of its own receptor and prevents TNF from triggering and immune response side effects: infections 2) infliximab: -monoclonal antibody to TNF (also used in other autoimmune diseases like crohns) -given in slow IV infusion -side effects: infections 3)anakinra: -IL-1 receptor anatagonist SE: infections
what is rheumatoid arthritis?
-it is an autoimmune disease most commonly occurring in women of childbearing age. -autoantibodies called rheumatoid factor (IgM against gig Fc receptors) deposit in joint and other tissues such as in kidneys causing glomerulonephritis and in skin causing rheumatoid nodules -treatment involves the use of immunomodulators which suppress the immune response
therapy of rheumatoid arthritis
-therapy involves use of NSAIDs initially for management of pain and iflammation -high doses of NSAIDs are required for an anti-inflammatory effect but this will carry the risk for more side effects -NSAIDs decrease pain and swelling but have no beneficial effect in the course of the disease DMARDS (disease modifying Anti- Rheumatic Drugs): -these are immunomodulators that are thought to slow down the progression of the disease -At initial diagnosis, they may be started with NSAIDs if symptoms are severe as DMARDs usually take 2 weeks - 6months to work most common DMARDS used: -hydroxychloroquine- often recommended for MILD arthritis -methotrexate- for moderate-severe RA -other DMARDS used less frequently, sometimes in combination regimens for refractory cases
Drugs used in RA
1) hydroxychloroquine: -for mild arthritis -stabilises lysosomes and decreases chemotaxis side effects include: GI distress, visual dysfunction, cinchonism, haemolytic in G-6-P-D deficient patient 2)methotrexate: -for moderate-severe arthritis - dihydrofolate educate inhibitor and cytotoxic to lymphocytes which means less autoantibodies are made side effect: Bone marrow suppression , gastroenteritis *methotrexate is also used for other autoimmune diseases like psoriasis* 3)sulfasalazie: -sulfonamde which is broken down by colonic bacteria into: sulfapyridine- which is absorbed in blood and used as a DMARD (it decreases B cell function) and 5-aminosalicylic acid (which in an NSAID that stays in the gut and used for ulcerative colitis) Side effects: haemolysis in G-6-P-d deficient patient 4)glucocorticoids: - decrease productions of leukotrienes, interleukins and platelet activating factor side effects: ACTH suppression, cushingoid state, osteoporosis, GI distress and glaucoma
other drugs
Gold salts:are uses rarely -decrease lysosomal and macrophage functions -side effects: dermatitis, haematotoxicity and nephrotoxicity pencillamine: -suppresses T-cell and circulating rheumatoid factors (more commonly pencillamine is used in wilson's disease as it is a chelator of copper) -side effectS: proteinuria, haematotoxicity, autoimmune disease leflunomide: inhibits the synthesis of ribonucleotides by inhibiting DHODP enzyme and arrests lymphocytes in G1 phase - anti-proliferative and cytostatic effect sie effects: alopecia, diarrhoea, BM suppression, hepatotoxicity (anti-neoplastic like effects)