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DMARD

Second line diverse groups of drugs.
Mechanism of action unclear- long term depression
Very slow onset

Sulphasalizine

DMARD
cheap and commonly 1st line drug in UK
sulphapyridine and salicylic acid combined- gut bacteria hydrolyze to 5-aminosalycilic and sulphapyridine.
Reduces absorption of antigens reduces chances of joint inflammation
Reduces synthesis of inflammatory mediators e.g ecosanoids and cytokines

Side Effect:
GI effect
reduction in sperm count
anaphylaxis

Drug side effect: Sulphasalizine

Gold

DMARD
Bind to tissue and accumulate widely including in synovium and inflamed joints
Inhibit induction of IL-2 and TNF-a
Inhibit lymphocyte proliferation

Side Effect: Agranulocytosis, aplastic anaemia, skin rashes, serious toxic effects in 10% of patients

Drug side effect: gold

Methotrexate

DMARD
Rapid action
First DMARD for RA and Crohns
Action not via dihydrofolate reductase
Accumulation of adenosine
Inhibition of T cells

Glucocorticosteroids

Give with low dose sulphasalizine and methotrexate
Immunosupressant
Side effects: GI, hypertension, diabetes skin rashes

Biologics

most end in 'mab'
Patients who have failed methotrexate
anti-TNF
Side effects: nausea, low grade fever, anorexia INCREASES CANCER SPREAD

Gout

Inhibit uric acid secretion
Inhibit uric acid synthesis
Give NSAID
inhibit inflammatory cell
Allopurinol
Colchicine
Probenecid and sulphinpyrazone

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