Disease modifying anti-rheumatic drugs (DMARDS)

Question 1

List the disease modifying anti-rheumatic drugs (DMARDS)

Answer 1

DMARDs = disease modifying anti-rheumatic drugs

• slow down progression of rheumatic drugs
• Slow acting effects on symptoms but significantly improve long term outcomes

Non-biological DMARDs:

• Methotrexate - gold standard for rheumatoid arthritis treatment
• Others - Leflunomide, sulfasalazine and hydroxychloroquine

Biological DMARDs:

• TNF inhibitors - e.g. infliximab
• B cell agents - e.g. rituximab
• Interleukin 6 inhibitors

Question 2

Describe the mechanism of action of the DMARDs and list the side effects of the DMARDs

Answer 2

Methotrexate (most common):

• Anti-proliferative and immunosuppressant
• Inhibits dihydrofolate reductase, thus inhibiting folic acid activation

Methotrexate adverse effects:

• Bone marrow suppression
• Liver accumulation
• Mouth ulcers
• Nausea
• Pneumonitis (lung infection)

Question 3

List the biological agents that are used in the treatment of rheumatic conditions

Answer 3

• TNF inhibitors - e.g. infliximab
• B cell agents - e.g. rituximab
• Interleukin 6 inhibitors