RHEUMATOID ARTHRITIS-MANAGEMENT (DMARDs & NON DMARDs)

SUMMARY

DMARD (first line)

1. Non-biologic agents: hydroxychloroquine, sulfasalazine, methotrexate, cyclosporin, azathioprine.
2. Biologic agents that inhibit TNF (anti-TNF): infliximab, adalimumab, certolizumab, and golimumab are monoclonal antibodies that bind and inactivate TNF.

3. Biologic agents that inhibit other factors: rituximab (anti-CD20 antibodies), anakinra (IL-1 antagonist), tocilizumab (IL-6 antagonist).

NON-DMARD (should only be used as adjuncts)
4. Aspirin (ASA), NSAIDs, COX-2 inhibitors. SE: GI ulceration and bleeding, renal insufficiency, hepatotoxicity, HTN.
5. Corticosteroids. SE: hyperglycemia, immune suppression, osteoporosis, peptic ulcer disease, steroid psychosis. Corticosteroids help to reduce acute inflammation but are less efficacious in the long term.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].