DMARDs (Disease Modifying Anti-Rheumatic Drugs)

Question 1

Quinolones

Answer 1

Class: Antimalarial

Mech: Reduces T-cell activation and chemotaxis

Thera: Rheumatoid, SLE

Tox: Chloroquine (only) will cause retinal damage

Misc: Used for patients who no longer respond to NSAIDs or cannot tolerate other DMARDs

Question 2

Glucocorticoids

Answer 2

Class: N/A

Mech: Inhibits phospholipase A2 (inhibiting release of AA and thus formation of prostaglandins)
Inhibits cytokine production (prevents induction of COX-2)

Thera: Rheumatoid, Acute gouty arthritis (can use intraarticular injection for local relief)

Tox: Cushingoid symptoms

Misc: Started initially (fast acting) before other drugs become effective. Can be oral or injection

Question 3

Sulfasalazine

Answer 3

Class: N/A

Mech: Likely inhibits IL-1 and TNF-alpha release

Thera: Rheumatoid

Tox: headaches, nausea, vomiting, skin rashes, neutropenia (30% d/c this drug bc of SEs)

Misc: Acts more quickly than other drugs

Question 4

Methotrexate

Answer 4

Class: Folate inhibitor

Mech: Inhibition of aminoimidazolecarboxamide (AICAR) transformylase and thymidylate synthetase with secondary effects on PMN chemotaxis.
Causes adenosine accumulation which inhibits inflammation

Thera: Rheumatoid

Tox: Nausea, stomatitis, hepatotoxicity

Misc: Takes several weeks to start working
Gold standard therapy

Question 5

Leflunomide

Answer 5

Class: N/A

Mech: Inhibits dihydroorate dehydrogenase which inhibits T-lymphocyte response to stimuli.

Thera: Rheumatoid

Tox: Diarrhea, hepatotoxicity

Misc: Takes several weeks to start working
Oral prodrug