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9 terms

Drugs for RA

STUDY
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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