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Chapter 73

Drug Therapy of Rheumatoid Arthritis

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Drugs for Rheumatoid Arthritis

Rheumatoid arthritis (RA) Autoimmune inflammatory disorder

Treatment Relieve symptoms Maintain joint function Minimize systemic involvement Delay progression of disease

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Classes of Antiarthritic Drugs

NSAIDs Nonsteroidal anti-inflammatory drugs

DMARDs Disease-modifying antirheumatic drugs

Glucocorticoids Adrenal corticosteroids

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Drug Selection for Rheumatoid Arthritis

Protocol Start with NSAIDs If symptoms persist, add DMARDs Glucocorticoids may be added until DMARDs take

effect

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DMARDs I: Major Nonbiologic DMARDs

Methotrexate Sulfasalazine

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Methotrexate

Most rapid-acting DMARD Therapeutic effect: 3 to 6 weeks Adverse effects

Hepatic fibrosis Bone marrow suppression GI ulceration Pneumonitis

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Sulfasalazine

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

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Other DMARDs I: Major Nonbiologic DMARDs

Leflunomid (Arava) Hydroxychloroquine (Plaquenil)

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DMARDs II: Major Biologic DMARDs

Tumor necrosis factor inhibitors Suppress immune function Pose risk of serious infection Work by neutralizing tumor necrosis factor (TNF)

• Etanercept (Enbrel)• Infliximab (Remicade)• Adalimumab (Humira)

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Etanercept

New DMARD Inactivates TNF

Use Moderate to severe RA

Adverse effects Infection (may be serious) Injection-site reactions Tuberculosis Heart failure Cancer Other adverse effects