Pharmacotherapy Options in Rheumatoid Arthritis

Abstract

Drugs form the mainstay of therapy in rheumatoid arthritis (RA). Five main classes of drugs are currently used: analgesics, non-steroidal anti-inflammatories (NSAIDs), glucocorticoids, nonbiologic and biologic disease-modifying antirheumatic drugs. Current clinical practice guidelines recommend that clinicians start biologic agents if patients have suboptimal response or intolerant to one or two traditional disease modifying agents (DMARDs). Methotrexate, sulfasalazine, leflunomide and hydroxychloroquine are the commonly used DMARDs. Currently, anti-TNF is the commonly used first line biologic worldwide followed by abatacept and it is usually combined with MTX. There is some evidence that tocilizumab is the most effective biologic as a monotherapy agent. Rituximab is generally not used as a first line biologic therapy due to safety issues but still as effective as anti-TNF. The long term data for the newer oral small molecule biologics such as tofacitinib is not available and hence used only as a last resort.

Hydroxychloroquine and Chloroquine Retinopathy

“…1 Despite its favorable efficacy and safety profile in comparison with its more toxic predecessor, chloroquine (Aralen, Sanofi Aventis, Bridgewater, NJ) (CQ), retinal toxicity remains a widely recognized side effect of its long-term use. Although HCQ retinopathy has been reported at a cumulative dose as low as 57 g, the prevalence of this complication is low during the first 5 years of therapy.…”

Rheumatoid Arthritis: A Brief Overview of the Treatment

“…They have not been used recently due to the more effective treatments, particularly MTX. Other immunosuppressive medications like azathioprine (Imuran), cyclophsphamide (Cytoxan), chlorambucil (Leukeran), and cyclosporine (Sandimmune) can be employed but are typically reserved for patients with very aggressive RA or complications of the disease [22, 23]. …”

Effects of Aqueous and Ethanol Root Extracts of Olax subscopioidea on Inflammatory Parameters in Complete Freund’s Adjuvant-Collagen Type II Induced Arthritic Albino Rats

“…These drugs lower the associated pain and inflammation and also decrease the progression of the disease. 26 Due to the adverse effects of NSAIDS and DEMARDS use and the cost of the drugs, more number of arthritic patients demand and prefer alternative medicines, hence the use of herbal preparations. 27 The systemic injection of chicken type II collagen -CFA in experimental animals like rats, models human arthritis, resulting in polyarthritis and systemic disease that mimics transformations as is found in human rheumatoid arthritis.…”