OR:an autoimmunedisease
that occurs when the body's own immune system mistakenly attacks the synovium.Rheumatoid arthritis is a chronic disease
NOTE:
Rheumatide arthritis is a joint disease that can occur at any age bt arthritis is a term used for joint disease that occur only in old bronze age
Difference in physical appearence of signs between rheumatide arthritis and gout is that in gout no joint inflammations are seen but in arthritis
Causes
- joint pain
- stiffness
- swelling
- loss of joint function
Drug
Classification :
Ø NSAIDS.
Ø DMARDs
Ø Immunosuppressant
Ø Glucocorticoids
Ø Antibiotic
Dmards :
These are charracterised as disease
modifying Anti-rheumatic drugs
Classified as:
1:Synthetic dmards
2:Biologic dmards
Synthetic
DMARDS:
v Methotrixate
v Sulfasaline
v Leflunomide
v Hydroxichloroquinine
v monocycline
BIOLOGIC
DMARDS
¨ Abatacept
¨ Rituximab
¨ Tocilizumab
(these
are some TNF recepter inhibitiors)
Leflunomide:
Mechanism of action:
IT ACTS ON DIHYDROORATE
DEHYDROGENASE ENZYME
Clinical uses
v Reduces
pain
v Slows
progression of Stuctural damage
Adverse Effects:
v Diarrhea
v Headache
v Nausea
v Skin
rashes
v Mild
alopecia
v hypertention
Contraindications
v contraindicated in pregnancy.
v Use
with caution in hepatic patients
v Use
with caution in patients with renal insufficency .
Salfasaline:
Mechanism of action:
v Decreases
production of IgA & IgM
v Suppression
of t cell response
v Inhibition
of in vitro b cell proliferation
Clinical uses:
v Effective
in rheumatoid arthritis
v Effective
in radiologic disease progression
Adverse effects:
v Nausea
v Vomiting
v Headache
v rashes
Minocycline:
minocycline is one of the tetracycline
used
in early, mild case of
rheumatic arthritis
Mechanism of action:
Not well known but
do have
anti inflammatory effect INCLUDING ABILITY TO
DESTROY COLLAGENASE
ENZYME (this
enzyme has ability to desolve bone)
¨ Dose:
have daily dose of
200mg.
Adverse effects:
adverse effects
are uncommon except for dizziness for 10
percent
¨ refferences
¨ Lippincot
¨ katezeng
Cyclosporine
Cyclosporine are Immunosuppressant involve in the
production of therapeutics effects in rheumatism.
Mechanism of Action
It inhibit production of interleukin 1, interleukin 2.
Secondarily it inhibit
macrophage –T cell interaction and T cell responsiveness.
Indication
Approved in use in arthritis.
Retard the appearance of new bony erosion.
Adverse effects
Nephrotoxicity
Hypertension
Gold salts
The
class of drugs having ability to prevent further rheumatic injury, but cannot
repair the existing damage
Drugs Available.
Auranofin
Mechanism of Action
It retard the progressing and articular distruction.
They inhibit cyclooxygenase (cox) enzyme.
Adverse effects
• They
cause serious toxicity that’s why not used majorly.
• Metallic
taste in mouth.
• Skin
rashes.
• Leucopenia.
Toxic Reaction of
Gold Salts
Skin (minor reaction).35/60
Mouth .. .. .. .. .. .. 7/60
Kidney…………………. 5/60
General .. .. .. .. .. .. 4/60
Skin (major reaction). 2/60
Glucocorticoids
Effects
of This class of therapy are prompt and are capable of slowing.
Available Drugs
Prednisolone
Dexamethasone
Prednisone
Mechanism of Action
It inhibit the production of archidonic acid.
Inhibits accumulation lymphocytes at injury area. And
suppresses phagocytic activity.
Adverse Effects
Prolong use cause disabling toxic effects.
Withdrawal effects
NSAIDs
Non steroidal anti inflammatory drug.
Usually, only one such NSAID should be given at a time.If the pain and swelling persist then combination therapy
with NSAIDs should use.
Mechanism Of Action
NSAIDs work by blocking the production of certain chemicals
(cox1 & cox2) in the body that cause inflammation.
Adverse effects
- GI/Ulcers
- Hepatotoxicity
- Nephrotoxicity
- Bleeding – antiplatelet
- Rash
References::
Basic pharmacology by lipencoart.
Basic pharmacology by katzeng.
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