DMARD anti-rheumatic drug

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... 

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. 

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. 

FIGURE 89-4. Algorithm for treatment of rheumatoid arthritis. RA, rheumatoid arthritis NSAID, nonsteroidal anti-inflammatory drugs Rx, therapy DMARD, disease-modifying anti rheumatic drug. 

Hematologic In a postmarketing Swedish cohort study (n = 820) the incidence of hematological disorders in patients treated with etanercept was 3.4 per 1000 patient-years [106 ]. However, half of these patients were using at least one other disease-modifying anti-rheumatic drug (DMARD), in most cases methotrexate, and attribution was not clear. 

Because of the risk of serious side effects with long-term use, treatment of rheumatic disease with corticosteroids is controversial. They should generally be reserved for patients in whom other anti-inflammatory drugs are unsuccessful or until other drugs take effect (see DMARDs below). However, the use of corticosteroids does depend on individual... 

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