B.

SC II YEAR
Disease modifying agents

 The following drugs are considered

DMARDs: methotrexate, hydroxychloroquine, sulfasalazi
ne, leflunomide,
 TNF-alpha inhibitors
(certolizumab, adalimumab, infliximab ,
and etanercept), abatacept,
and anakinra. Rituximab and tocilizumab are monoclonal
antibodies and are also DMARDs.
 The use of tocilizumab is associated with a risk of
increased cholesterol levels.
Hydroxychloroquine, apart
from its low toxicity profile,
is considered effective in
the moderate RA treatment
 Leflunomide is effective when
used from 6–12 months, with
similar effectiveness to
methotrexate when used for 2
years.
 A 2015 Cochrane review found rituximab with
methotrexate to be effective in improving symptoms
compared to methotrexate alone.
 Rituximab works by decreasing levels of B-cells
(immune cell that is involved in inflammation). People
taking rituximab had improved pain, and function,
reduced disease activity and reduced joint damage
based on x-ray images. After 6 months, 21% more
people had improvement in their symptoms using
rituximab and methotrexate
 Biological DMARD agents used to treat
rheumatoid arthritis include: tumor
necrosis factor alpha (TNFα) blockers
such as infliximab; interleukin 1 blockers
such as anakinra, monoclonal
antibodies against B cells such
as rituximab, interleukin 6 blockers such
as tocilizumab, and T cell co-stimulation
blockers such as abatacept.
Glucocorticoids can be
used in the short term
and at the lowest dose
possible for flare-ups and
while waiting for slow-
onset drugs to take
effect.
 NSAIDs reduce both pain and
stiffness in those with RA but do not
affect the underlying disease and
appear to have no effect on people's
long term disease course and thus are
no longer first line agent