Antirheumatic drug

Table 2. Traditional Antirheumatic Drugs Having Immunological Activity ...

From the various modifications that have been made on the phenylbutazone structure in order to increase activity and reduce toxicity it has been found that the activity persists when methyl, chloro, hydroxy or nitro groups are introduced into the para position of one or both benzene rings (see oxyphenbutazone (712) as an example). Mofebutazone (714) has also been used in Europe for several years as an antirheumatic drug. 

DL-CFU Dendritic cell/Langerhans cell colony forming DLE Discoid lupus erythematosus DMARD Disease-modifying antirheumatic drug... 

It is imperative that the initiation of one or more disease-modifying antirheumatic drugs occurs in all patients within the first 3 months of diagnosis to reduce joint erosion. 

Methotrexate is the disease-modifying antirheumatic drug of choice because of its documented efficacy and safety profile when monitored appropriately. 

FIGURE 54-2. Outl ine of the management of rheumatoid arthritis. (From Guidelines for the management of rheumatoid arthritis 2002 update. Arthritis Rheum 2002 46(2) 328-346, with permission.) DMARD, disease-modifying antirheumatic drug NSAID, nonsteroidal antiinflammatory drug ... 

DMARD disease-modifying antirheumatic drug ESR erythrocyte sedimentation rate... 

Cush JJ. Safety overview of new disease-modifying antirheumatic drugs. Rheum Dis Clin North Am 2004 30 237-255. 

A disease-modifying antirheumatic drug (DMARD) should be started within the first 3 months of symptom onset (Fig. 4-1). DMARDs should be used in all patients except those with limited disease. Early use of DMARDs results in a more favorable outcome and can reduce mortality. 

Usual Doses and Monitoring Parameters for Antirheumatic Drugs... 

Methotrexate is one of the disease-modifying antirheumatic drugs, which are administered once a week. The initial dose is 7.5 mg administered once a week and the maximum dose is 15-20 mg administered once a week. 

The first-line agents in the treatment of rheumatoid arthritis are non-steroidal anti-inflammatory drugs such as diclofenac. Diclofenac and indometacin, another NSAID, tend to have similar activity hov/ever, indometacin has a higher incidence of side-effects and therefore diclofenac is more appropriate for initial treatment. Sodium aurothiomalate is classified as a disease-modifying antirheumatic drug and is used as a second-line treatment in rheumatoid arthritis, but has been superseded by methotrexate, administered v/eekly. Paracetamol is often indicated in the management of osteoarthritis. Local intra-articular injections of dexamethasone may be administered for the relief of soft-tissue inflammatory conditions. 

Polyarticular-course juvenile rheumatoid arthritis (JRA) For reducing signs and symptoms of moderately to severely active polyarticular-course JRA in patients who have had an inadequate response to at least 1 disease-modifying antirheumatic drug (DMARD). 

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