Second line diverse groups of drugs.
Mechanism of action unclear- long term depression
Very slow onset
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
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
First DMARD for RA and Crohns
Action not via dihydrofolate reductase
Accumulation of adenosine
Inhibition of T cells
Give with low dose sulphasalizine and methotrexate
Side effects: GI, hypertension, diabetes skin rashes
most end in 'mab'
Patients who have failed methotrexate
Side effects: nausea, low grade fever, anorexia INCREASES CANCER SPREAD