Anti-rheumatic drugs

Disease-modifying Anti-rheumatic Drugs (DMARDs)... 

The treatment approach to RA has undergone a major evolutionary change in recent years with a move away from predominantly symptomatic treatment approaches towards much earlier intervention with diseasemodifying anti-rheumatic drug (DMARD) therapy and... 

E. C. Huskisson (ed.), Anti-Rheumatic Drugs, Praeger Publishers, New York, 1983, pp. 523-524. 

Unfortunately, a substantial proportion of patients with autoimmune inflammatory diseases have become refractory to NSAIDs, and/or oral or intravenous Disease Modifying Anti Rheumatic Drugs (DMARDs). However, oral combinations of DMARDs generate better outcomes compared to single drug therapy in autoimmune disease. Even autoimmune diseases can become refractory to oral DMARD combinations. 

K. D. Rainsford (1985). Anti-inflammatory and Anti-rheumatic Drugs, 3 vols. Boca Raton CRC... 

Garrood T, Scott DL. Combination therapy with disease modifying anti-rheumatic drugs in rheumatoid arthritis. BioDrugs. 2001 15 543-561. 

M.J.M. Wijnands, and P.L.C.M. Van Riel, Management of adverse effects of disease modifying anti-rheumatic drugs. Drugs Saftey 13 219-227, 1995. 

Only trained medical personnel can prescribe DMARDs like aura-nofin, but there are others such as chloroquine, methotrexate, penicillamine, and sulfasalazine. Chloroquine was originally developed as an antimalarial drug but was found to have some anti-rheumatic activity. Methotrexate acts on the immune system and was particular favoured by doctors for the treatment of arthritis in the 1990s because it could be prescribed on a long-term basis. Penicillamine is effective but needs to be taken for many months before its benefits appear. Sulfasalazine was specifically developed as an anti-rheumatic drug and... 

DMARD = disease modifying anti-rheumatic drug. 

Kourounakis Rekka ADVANCED DRUG DESIGN AND DEVELOPMENT Labaune HANDBOOK OF PHARMACOKINETICS The Toxicity Asssessment of Chemicals Macheras, Reppas Dressman BIOPHARMACEUTICS OF ORALLY ADMINISTERED DRUGS Martinez PEPTIDE HORMONES AS PROHORMONES Rainsford ANTI-RHEUMATIC DRUGS Actions and Side Effects... 

Te use of NSAIDS and other anti-inflammatory therapies are similar to those used in other autoimmune arthritic disorders. Corticosteroid injections for severe pain and inflammation at specific joints are standard therapy. For severe forms of the disease immunomodulating anti-rheumatic drugs such as methotrexate and sulfasalazine are effective. As with other similar disorders, the biologic TNF a inhibitors are currently prescribed for severe Reiter s syndrome. 

In eight children with juvenile rheumatoid arthritis, who had failed to respond to disease-modifying anti-rheumatic drugs, high-dose etanercept was well tolerated (35). None withdrew because of etanercept-related adverse events. One child reported transient erythema at the injection site after the first injection. Three had mild transient upper respiratory tract infections. There were no laboratory abnormalities. 

Leflunomide has anti-inflammatory, immunosuppressive, and virustatic effects. Its efficacy has been demonstrated in patients with rheumatoid arthritis and psoriatic arthritis and other conditions in randomized, double-blind, placebo-controlled trials and other studies (8-32), and it was approved for treatment of adult rheumatoid arthritis in August 1998 (Table 1) (33). In three large phase III trials (US301, n = 482 MN301, n = 358 MN302, n = 999), leflunomide was as effective and well tolerated as methotrexate and sulfasalazine and superior to placebo (34). These data were confirmed by a meta-analysis (35,36). Leflunomide is therefore indicated for patients with rheumatoid arthritis who have failed first-line disease modifying anti-rheumatic drug therapy on the basis of efficacy, safety, and costs (36). It is effective as monotherapy and in combination with methotrexate or infliximab (6). 

Scott DL. Interstitial lung disease and disease modifying anti-rheumatic drugs. Lancet 2004 363(9416) 1239 0. 

Kale VP, Bichile LS. Leflunomide a novel disease modifying anti-rheumatic drug. J Postgrad Med 2004 50(2) 154-7. 

Dijkmans BA, de Vries E, de Vreede TM. Synergistic and additive effects of disease modifying anti-rheumatic drugs combined with chloroquine on the mitogen-driven stimulation of mononuclear cells. Clin Exp Rheumatol 1990 8(5) 455-9. 

Grove ML, Hassell AB, Hay EM, Shadforth MF. Adverse reactions to disease-modifying anti-rheumatic drugs in clinical practice. QJM 2001 94(6) 309-19. 

Wylie G, Appelboom T, Bolten W, Breedveld FC, Feely J, Teeming MR, Le Loet X, Manthorpe R, Marcolongo R, Smolen J. A comparative study of tenidap, a cytokine-modulating anti-rheumatic drug, and diclofenac in rheumatoid arthritis a 24-week analysis of a 1-year clinical trial. Br J Rheumatol 1995 34(6) 554-63. 

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