Rheumatoid arthritis (RA) is a chronic inflammatory, autoimmune disorder affecting joints and sometimes extra-articular sites.
Disease-Modifying Anti-Rheumatic Drugs (DMARDs): Slow disease progression, reduce joint destruction and disability.
Classification of Anti-Rheumatic Drugs
1) Non-Steroidal Anti-Inflammatory Drugs (NSAIDs):
Examples: Ibuprofen, Diclofenac, Naproxen
Mechanism of Action: Block prostaglandin synthesis by inhibiting COX enzymes, reducing inflammation and pain.
Use: Symptomatic relief but do not modify disease progression.
Side Effects: GI ulcers, cardiovascular risks.
2) Corticosteroids (Glucocorticoids):
Examples: Prednisone, Methylprednisolone
Mechanism of Action: Suppress inflammation and modulate the immune response.
Use: Short-term management of severe inflammation or flares.
Side Effects: Osteoporosis, diabetes, infections with long-term use.
3) Disease-Modifying Anti-Rheumatic Drugs (DMARDs):
These drugs slow disease progression and prevent joint damage.
A) Conventional Synthetic DMARDs:
Methotrexate: Inhibits dihydrofolate reductase, suppressing T-cell activation. (Most commonly used).
Leflunomide: Inhibits pyrimidine synthesis, reducing lymphocyte proliferation.
Sulfasalazine: Anti-inflammatory and immunomodulatory effects.
Hydroxychloroquine: Inhibits antigen processing and cytokine release.
Side Effects: Liver toxicity, bone marrow suppression, GI distress, and lung toxicity.
B) Biologic DMARDs (Targeted Therapy):
Target specific immune mediators like TNF-alpha, IL-6, or B-cells.
Examples:
TNF Inhibitors: Etanercept, Infliximab, Adalimumab
IL-6 Inhibitor: Tocilizumab
B-cell Depleter: Rituximab
T-cell Inhibitor: Abatacept
Side Effects: Risk of infections (e.g., tuberculosis reactivation), malignancies, injection site reactions.
C) Targeted Synthetic DMARDs (JAK Inhibitors):
Examples: Tofacitinib, Baricitinib
Mechanism of Action: Inhibit Janus kinase (JAK) enzymes, blocking cytokine signaling pathways.
Side Effects: Blood clots, infections, and malignancies.
Key Differences Between Antigout and Anti-Rheumatic Drugs:
Feature | Antigout Drugs | Anti-Rheumatic Drugs |
Purpose | Treat gout by lowering uric acid or reducing pain. | Treat rheumatoid arthritis by modifying disease or reducing inflammation. |
Mechanism of Action | Focus on uric acid metabolism or inflammation. | Target immune modulation and inflammation pathways. |
Duration of Therapy | Often long-term for chronic gout management. | Lifelong in most cases for RA to prevent progression. |
Drug Classes | NSAIDs, Colchicine, ULT, Corticosteroids. | NSAIDs, Corticosteroids, DMARDs (synthetic, biologic). |