Chapter 73
Drug Therapy of Rheumatoid
Arthritis
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
Drugs for Rheumatoid Arthritis
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Rheumatoid arthritis (RA)
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
Autoimmune inflammatory disorder
Treatment
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
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Relieve symptoms
Maintain joint function
Minimize systemic involvement
Delay progression of disease
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Classes of Antiarthritic Drugs
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NSAIDs
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DMARDs
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Nonsteroidal anti-inflammatory drugs
Disease-modifying antirheumatic drugs
Glucocorticoids
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Adrenal corticosteroids
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Drug Selection for
Rheumatoid Arthritis
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Protocol
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Start with NSAIDs
If symptoms persist, add DMARDs
Glucocorticoids may be added until DMARDs take
effect
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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DMARDs I: Major
Nonbiologic DMARDs
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
Methotrexate
Sulfasalazine
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Methotrexate
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Most rapid-acting DMARD
Therapeutic effect: 3 to 6 weeks
Adverse effects
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Hepatic fibrosis
Bone marrow suppression
GI ulceration
Pneumonitis
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Sulfasalazine

Used to treat inflammatory bowel disease
(IBD); now used for RA as well
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
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Anti-inflammatory and immunomodulatory actions
Can slow progression of joint deterioration
GI side effects may be intolerable
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Other DMARDs I: Major
Nonbiologic DMARDs


Leflunomid (Arava)
Hydroxychloroquine (Plaquenil)
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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DMARDs II: Major
Biologic DMARDs
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Tumor necrosis factor inhibitors
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Suppress immune function
Pose risk of serious infection
Work by neutralizing tumor necrosis factor (TNF)
• Etanercept (Enbrel)
• Infliximab (Remicade)
• Adalimumab (Humira)
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Etanercept
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New DMARD
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Use

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Inactivates TNF
Moderate to severe RA
Adverse effects
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Infection (may be serious)
Injection-site reactions
Tuberculosis
Heart failure
Cancer
Other adverse effects
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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