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Chapter 73

Chapter 73. Drug Therapy of Rheumatoid Arthritis. Drugs for Rheumatoid Arthritis. Rheumatoid arthritis (RA) Autoimmune inflammatory disorder Treatment Relieve symptoms Maintain joint function Minimize systemic involvement Delay progression of disease. Classes of Antiarthritic Drugs.

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Chapter 73

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  1. Chapter 73 Drug Therapy of Rheumatoid Arthritis

  2. Drugs for Rheumatoid Arthritis • Rheumatoid arthritis (RA) • Autoimmune inflammatory disorder • Treatment • Relieve symptoms • Maintain joint function • Minimize systemic involvement • Delay progression of disease

  3. Classes of Antiarthritic Drugs • NSAIDs • Nonsteroidal anti-inflammatory drugs • DMARDs • Disease-modifying antirheumatic drugs • Glucocorticoids • Adrenal corticosteroids

  4. Drug Selection for Rheumatoid Arthritis • Protocol • Start with NSAIDs • If symptoms persist, add DMARDs • Glucocorticoids may be added until DMARDs take effect

  5. DMARDs I: Major Nonbiologic DMARDs • Methotrexate • Sulfasalazine

  6. Methotrexate • Most rapid-acting DMARD • Therapeutic effect:3 to 6 weeks • Adverse effects • Hepatic fibrosis • Bone marrow suppression • GI ulceration • Pneumonitis

  7. Sulfasalazine • Used to treat inflammatory bowel disease (IBD); now used for RA as well • Anti-inflammatory and immunomodulatory actions • Can slow progression of joint deterioration • GI side effects may be intolerable

  8. Other DMARDs I: Major Nonbiologic DMARDs • Leflunomid (Arava) • Hydroxychloroquine (Plaquenil)

  9. DMARDs II: Major Biologic DMARDs • Tumor necrosis factor inhibitors • Suppress immune function • Pose risk of serious infection • Work by neutralizing tumor necrosis factor (TNF) • Etanercept (Enbrel) • Infliximab (Remicade) • Adalimumab (Humira)

  10. Etanercept • New DMARD • Inactivates TNF • Use • Moderate to severe RA • Adverse effects • Infection (may be serious) • Injection-site reactions • Tuberculosis • Heart failure • Cancer • Other adverse effects

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