Disease-modifying antirheumatic drugs DMARDs

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. 

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). 

B. Indications and use Kineret is indicated for the reduction in signs and symptoms of moderately to severely active rheumatoid arthritis in patients 18 years of age or older who have failed one or more disease-modifying antirheumatic drugs (DMARDs). Kineret can be used alone or in combination with DMARDs other than tumor necrosis factor (TNF) blocking agents. 

Another important group of agents is characterized as disease-modifying antirheumatic drugs (DMARDs). They decrease inflammation, usually improve symptoms, and slow the bone damage associated with rheumatoid arthritis. They are thought to affect more basic inflammatory mechanisms than do glucocorticoids or the NSAIDs. They may also be more toxic than those alternative medications. 

In general, disease modifying antirheumatic drugs (DMARDs) are immune modulators that are believed to restore a more normal immune environment... 

However, the rate of adverse effects associated with leflunomide was significantly lower than with methotrexate and other disease-modifying antirheumatic drugs (DMARDs) in an analysis of 40 594 patients with rheumatoid arthritis (8,51). The incidences of adverse events per 1000 patient-years were as follows ... 

Cannon GW, Holden WL, Juhaeri J, Dai W, Scarazzini L, Stang P. Adverse events with disease modifying antirheumatic drugs (DMARD) a cohort study of leflunomide compared with other DMARD. J Rheumatol 2004 31(10) 1906-11. 

In a comprehensive study of 158 Japanese patients with rheumatoid arthritis, there was an obvious relation between membranous nephropathy and exposure to disease-modifying antirheumatic drugs (DMARDs) in 40 of 49 patients (231). In this study penicillamine (15%), bucillamine (67%), and gold compounds (17%) clearly predominated. 

Chemicae/Pharmaceuticae/Other Ceass Immunosuppressive antimetabolite Disease modifying antirheumatic drug (DMARD)... 

Disease-modifying antirheumatic drugs (DMARDs) or biological agents should be started within 3 months of the diagnosis of rheumatoid arthritis. 

Disease-modifying antirheumatic drugs (DMARDs) are thought to slow disease progression and may be started with NSAIDs at the time of initial diagnosis, especially if symptoms are severe. Hydroxychloroquine is often recommended for mild arthritis and methotrexate (MTX) for moderate to severe RA. Other DMARDs (see Table VI-1-3) are used less frequently, sometimes in combination regimens for refractory cases. 

Disease-modifying antirheumatic drugs (DMARDs) are thought to slow disease progression and may be started with NSAIDs at the time of initial diagnosis,... 

Table VI-5-1. Disease-Modifying Antirheumatic Drugs (DMARDs)...

NSAIDs are commonly used to help alleviate the pain and inflammation associated with rheumatoid arthritis. However, they have no effect on the progress of the disease. Disease-modifying antirheumatic drugs (DMARDs) are used with the hope of slowing the disease progress. Table VI-5-1 summarizes the mechanisms of action and the adverse effects of the DMARDs. 

Older disease-modifying antirheumatic drugs (DMARDs) used frequently in rheumatoid arthritis include hydroxychloroquine, methotrexate, steroids, and sulfasalazine. Gold salts and penicillamine may be effective but cause severe toxicity (see Chapter 36). 

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