Rheumatoid Arthritis

definition

-autoimmune inflammaroty disorder 

joint inflammation---> destruction 

---treatment goal is to prevent further distruction

1. NSAID's
2. DMARD's (disease modifying antirheumatic drugs)
3. Glucocorticoids/ corticosteroids (local injection)

AntiArthritic Rx

DMARD's

first choice agents

1. methotrexate (DOC)
2. hydrochloroquine
3. sulfasalazine

etanercept

infliximab

adalimumab

golimumab

leflunomide

anakinra

abatacept

rituximab

tocilizumab

most RAPID acting DMARD (3-6 wks)

weekly oral adminictration

ADRs

-hepatic fibrosis (alchy)

-bone marrow suppression

-GI ulceration

-pneumonitis

hydrochloroquine

moderate acting: 3-6 months

retinal damage

ORAL

moderately rapid acting 

(methotrex>sulf>hydro)

used for ulcerative colitis

-dec effectiveness for RA

inactivation of TNF (tumor necrosis factor)

-involved with inflammation cascade

indicated for moderate to severe RA

SUB Q injection

ADR's

POSSIBLE SERIOUS INFECTION

similar action to etanercept (TNF blocker)

also possible risk of infection

--inflix: given IV

--adalim: injection

non biologic DMARD

-decreases t lymphocyte proliferation

ORALLLLL

ADRs

same (SERIOUS infection)

blocks interlukin-1 (IL-1) which is involved in inflammation

same ADRs

golimumab (anti TNF)

abatacept (t cell inhibitor)

rituximub (tcell inhibitor and orig for lymphoma)

newest anti RA Rx

interlukin 6 inhibitor

same risk for infection