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Disease –Modifying Anti-rheumatic Drugs ( DMARDs)

Disease –Modifying Anti-rheumatic Drugs ( DMARDs) . Slow Acting Anti-inflammatory Drugs. DEFINITION. Drugs used to relief pain & inflammation. General Features. Low doses commonly are used early in the course of the disease. Used when the disease is progressing & causing deformities .

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Disease –Modifying Anti-rheumatic Drugs ( DMARDs)

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  1. Disease –Modifying Anti-rheumaticDrugs ( DMARDs) Slow Acting Anti-inflammatory Drugs

  2. DEFINITION • Drugs used to relief pain & inflammation

  3. General Features • Low doses commonly are used early in the course of the disease. • Used when the disease is progressing & causing deformities . • Can not repair existing damage, but prevent further progressing , injury or deformity • Have no analgesic effects • Their effects need from 6 weeks to 6 months to be evident

  4. Clinical Uses • Treatment of different types of arthritis as rheumatoid arthritis rheumatic arthritis • Musculoskeletal pain • Ankylosingspondylitis .

  5. Hydroxychloroquine • Mechanism of action : • Inhibition of lysosomal enzyme activity • Trapping of free radicals ( H2O2) • Suppression of T lymphocytes • Suppression of leukocytes actions • Large doses for a long duration are used for treatment of arthritis

  6. Adverse Effects • Nausea & vomiting • Irrreversible retinal damage • Corneal deposits • Allergic skin reactions • Cinchonism ( tinnitus & vertigo)

  7. Methotrexate • Mechanism of Action • Inhibition of polymorphonuclearchemotaxis • Dihydrofolatereductase inhibitor

  8. Adverse Effects • Nausea • Mucosal ulcers • Bone marrow depression • Hepatotoxicity is dose related

  9. Tumor necrosis factor-α(TNF-α) blocking agents Infliximab • Mechanism of action • is a chimeric ( 25% mouse , 75% human) antibody. • Binds with high affinity to human TNF-α resulting in inhibition of macrophage & T cell function.

  10. Infliximab • Given as IV infusion • Half-Life 8-12 days • Given every 8 weeks regimen. • Infliximab elicits up to 62% incidence of human antichimeric antibodies. • Concurrent therapy with methotrexate decreases the prevalence of human antichimeric antibodies

  11. Adverse Effects • Upper respiratory tract infections • Headache • Cough • Activation of latent tuberculosis • Infusion site reaction

  12. Comparison DMARDs NSAIDs • Slow onset of action • 6 weeks-6 months • Arrest the progression of the disease. • Prevent formation of new deformity. • Used in chronic cases when deformity is exciting • Rapid onset of action • Few minutes –few hours • No effect on the progression of the disease • Can not stop the formation of new deformity. • Used in acute cases to relief inflammation & pain

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