DMARDS

Question 1

Hydroxychloroquine

Answer 1

mild RA
safe in pregnancy
MOA
Inhibits
1. TLR signaling
2. Antigen presentation 
SIde effects
1. Rare ocular toxicity

-often combined with Sulfasalazine

Question 2

Sulfasalazine

Answer 2

• Prodrug: Sulphapyridine/5-aminosalicylic acid
• metabolized to active component by colonic bacteria

Mild RA
Safe in preg

MOA
inhibits T and B cells, probably NF Kb

Side Effects

1. Hepatotoxicity
2. Agranulocytosis (rare)

Question 3

Methotrexate

Answer 3

DRUG OF CHOICE
moderate/severe RA
no preg/no liver disease/or renal impairment

MOA
increases adenosine leading to immunosuppression

Adverse Side effects

1. Hepatotoxicity-can’t drink-can’t give with liver disease
2. Pulmonary toxicity
3. BM suppression
4. risk of lymphoma

Question 4

Leflunomide

Answer 4

oral& low cost
NO preg/no liver disease
MOA
1. inhibitor of dihydroorotate dehydrogenase
2. no uridine synthesis
3. no RNA (G1 cycle arrest)
4. inhibit T and B cell immune response

Adverse

1. hepatotoxicity (esp with MTX)
2. Hypertension (esp with NSIADS)
3. Diarrhea, nausea