Corticosteroids

Prednisone (Deltasone®)

Triamcinolone (Kenacort®)

Methylprednisolone (Solu-Medrol®)

MOA: Inhibits prastaglandin and leukotriene synthesis, inhibits neutrophil and monocyte superoxide radical generation

AE: Osteoporosis, myopathies, hypertension, gastritis, glucose intolerance, increased susceptibility to infections, skin atrophy, weight gain

Often used as bridge therapy for patients on DMARDS

Prednisone

Deltasone®

Oral Corticosteroids

Triamcinolone

Kenacort®

Intra-articular Corticosteroids

Methylprednisolone

Solu-Medrol®

Intra-articular Corticosteroids

 NSAIDS

(Non-steroidal Anti-inflammatory Drugs)

Aspirin

Diclofenac (Voltaren®)

Etodolac (Lodine®)

Ibuprofen (Motrin®, Advil®)

Naproxen (Naprosyn®, Aleve®)

Nabumetone (Relafen®)

Sulindac (Clinoril®)

Tolmentin (Tolectin®)

NSAIDS

MOA: Inhibition of COX-1 and COX-2, inhibition of COX 2 is responsible for the anti-inflammatory effects of NSAIDS

AE: Gastrointestinal effects (dyspepsia, gastric and duodenal ulcers)

Aspirin

Several Brand Names Available

Dose: 650 mg every 4 hours, Max= 6000 mg

NSAIDS

Diclofenac

Voltaren®

Dose: 75 mg BID, Max= 200 mg

NSAIDS

Etodolac

Lodine®

Dose: 300 mg BID, Max= 1200 mg

NSAIDS

Ibuprofen

Advil®, Motrin®

Dose: 400 mg TID, Max= 3200 mg

NSAIDS

Naproxen

Naprosyn®, Aleve®

Dose: 500 mg BID, Max= 1250 mg

NSAIDS

Nabumetone

Relafen®

Dose: 500 mg BID, Max= 2000 mg

NSAIDS

Sulindac

Clinoril®

Dose: 150 mg BID, Max= 400 mg

NSAIDS

Tolmentin

Tolectin®

Dose: 400 mg TID, Max= 1800 mg

NSAIDS

Celecoxib

Celebrex®

MOA: Inhibits COX-2

Dose: 100 mg BID, Max= 400 mg

COX-2 Inhibitor

**The other two have been taken off the market**

Non-Biological Disease Modifying Anti-Rheumatic Drugs (DMARDS)

Methotrexate (Rheumatrex®)

Hydroxychloroquine (Plaquenil®)

Sulfsalazine (Azulfidine®)

Leflunomide (Arava®)

Gold Salts (Aurolate®)

Azathioprine (Imuran®)

Cyclophosphamide (Cytoxan®)

Cyclosporine (Neoral®)

Auranofin (Ridaura®)

D-penicillamine (Cupirimine®)

Methotrexate

Rheumatrex®

MOA: Immunosupressant, folate antimetabolite/antineoplastic agent, interferes with cell reproduction and induces a suppressive effect on rapidly proliferating cells and secretion of cytokines

Onset: 4-6 weeks

Dose: 7.5-15 mg weekly; increase by 2.5 mg increments every 2-4 weeks until a response is evident

Non-biological DMARD

Hydroxychloroquine

Plaquenil®

MOA: Antimalarial, inhibits prostaglandin synthesis

Dose: 200-300 mg BID

Onset: Delayed up to 6 weeks

Therapeutic failure if no response after 6 weeks

Important AE: Blurred vision (Retinopathy)

Non-biological DMARD

Sulfsalazine

Azulfidine®

MOA: Anti-inflammatory, immunomodulator

Dose: 500 mg BID, may increase to 1 gram BID

Onset: 2-3 months

AE: Lupus-like syndrome

Non-biological DMARD

Leflunomide

Arava®

MOA: Inhibits pyrimidine synthesis, causing a decrease in lymphocyte proliferation, and modulation of inflammation

Dose: After loading dose of 100 mg daily for 3 days, maintenance is 20 mg daily

AE: Hepatotoxicity

Pregnancy: X

Non-biological DMARD

Gold Salts

Aurolate®

Not used frequently

Dose: 6 mg daily or 3 mg BID, if response inadequate after 6 months increase to 9 mg, if response inadequate after 3 months, discontinue

AE: Gold toxicity

Not recommended for use during pregnancy

Non-biological DMARD

Azathioprine

Imuran®

MOA: Immunosupressant

Dose: 50-150 mg daily

Onset: 2-3 months

Used for refractory RA or systemic involvement such as rheumatoid vasculitis

Non-biological DMARD

Cyclophosphamide

Cytoxan®

MOA: Immunosuppressant, suppresses T-cell function

Limited for most severe cases of RA

Long-term use can increase risk of malignancy and infection

Non-biological DMARD

Cyclosporine

Neoral®

MOA: Inhibits T-cell activation, inhibits interleukin-2 and interferon gamma

Dose: 2.5 mg/kg/day and may increase to 5 mg/kg/day at 2-4 week intervals

Substrate of 3A4

AE: Nephrotoxicity, excessive hair growth, gingival hyperplasia

Non-biological DMARD

Auranofin

Ridaura®

Dose: 3-6 mg daily, may increase to 9 mg daily

Onset: 4-6 months

Non-biological DMARD

D-Penicillamine

Cupirimine®

Dose: 250-750 mg daily

Onset: 3-6 months

Non-biological DMARD

Tumor Necrosis Factor-alpha (TNFα) Inhibitors

Etanercept (Enbrel®)

Infliximab (Remicade®)

Adalimumab (Humira®)

Golimumab (Simponi®)

Certolizumab (Cimzia®)

TNFα Inhibitors

MOA: TNFα antibodies decrease synovitis and joint erosions in collagen-induced arthritis and when administered after disease onset it allows eroded joints to heal. 

Etanercept

Enbrel®

Dose: 25 mg Sub-Q twice a week

For patients that have not adequately responded to Non-biological DMARDS

TNFα Inhibitors (Biological DMARDS)

Infliximab

Remicade®

Dose: 3 mg/kg IV at weeks 0, 2, and 6 weeks, then every 8 weeks

Chimeric Monoclonal Antibody

TNFα Inhibitors (Biological DMARDS)

Adalimumab

Humira®

Human monoclonal antibody

TNFα Inhibitors (Biological DMARDS)

Golimumab

Simponi®

Human monoclonal antibody

TNFα Inhibitor (Biological DMARDS)

Certolizumab

Cimzia®

Humanized Monoclonal Antibody

TNFα Inhibitor (Biological DMARDS) 

 Anakinra

Kineret®

Dose: 100 mg daily Sub-Q 

Interleukin (IL)-1 Receptor Antagonist (Biological DMARDS)

Abatacept

Orencia®

T-Cell Activator Inhibitor (Biological DMARDS)

Rituximab

Rituxan®

Chimeric Monoclonal Antibody

Anti-CD20 Monoclonal Antibody (Biological DMARDS)

Tocilizumab

Actemra®

Humanized Monoclonal Antibody

Interleukin (IL)-6 Inhibitor