Rheum atoid Arthr itis

It chronic autoimmune disease

is multi
system of
•

unknown cause .

• The main characteristic

feature is
persistent inflammatory
synovitis of peripheral smaller joints .

Treatment
Drugs used
for :

used initial
• NSAIDs are
commonly in
management
of Rheumatoid arthritis ( RA ) ,
but the dose
required
marked
generally adverse
effects .

rheumatic
•
Disease modifying anti -

drugs ( DMARDS )

slow disease
are
thought to
progression
.

Methotrexate ( MTX ) the First choice

usually
•
is DMARD .
 Methotrexate

used much
•
It is
first choice DMARD and us at

lower doses ( 7.5mg weekly ) than required in

cancer
therapy ( 30mg daily )

Adverse effects :

( is GI irritation & stomatitis

iii ,
Pancytopenia
Interstitial
Ciii ,
Hepatotoxicity in pneumonitis .

Diabetes mellitus
Teratogenic.ly
-
"'

Obesity * is B cell
lymphoma
-

Kidney disease

Other DMARDS

&
( Mechanism

side effects )
 Gout
disease characterised elevated serum
°
It is a
by
Uric acid level .

water
•
Uric acid has low
solubility ,
thus
precipitated
in
joints .
kidney & subcutaneous tissues .

Acute Gout :

• It is manifested as severe inflammation of joints .

used
ii. NSAIDs are as initial
therapy for acute
gout
attacks .

Indomethacin be choice
-
can
Drug of .
 in Colchicine It faster acting
:
( is more
effective and

than NSAIDs but due to

higher toxicity
it used
in
rarely .

Mechanism Action
•

of :

ci , Binds to tubulin →
I,
Micro tubular Polymer izati
-
ON

( Metaphase arrest ) I, 17134

A.
leukocyte &
granulocyte
migration .

Neural mechanism
ciii It also A
gut motility through

• Side effects :

cii Diarrhea
acute )
cii , GI pain (

Iii , Hematuria
(

civ , Alopecia
in
Myelo suppression
( vis Gastritis

* in Peripheral Neuropathy ( longer me )

* Intra articular - corticosteroids can be used in

Refractory cases .

( Pred miso / one 40

followed by
-60mg / day ,

tapering doses over 1- 2 weeks )

 Chronic Gout :

between attacks
•
When
pain
&
stiffness persist in a
joint ,

has
gout become chronic .

Drug strategy ( prophylaxis ) : Reduction of Uric Acid Pool .

Febu stat
d)
Allopurinol & ✗ ☐
:( Drugs decreasing synthesis)

Mechanism Action
of :
•

Inhibit xanthine oxidase * Purine metabolism

* Uric acid

Side
•

effects :

- Rash
-

Abnormal LFT
Both drugs are

Acute attack of Goat ( contraindicated in

Acute gout )
 iii , Probenecid Sulfinpyrazone (
Drugs Increasing Excretion )
,

• Mechanism :

Urate
Inhibit Proximal tubular
reabsorption of
but <
ineffective if GFR 50mL / min .

Pharmacokinetics :

gt is
completely absorbed
orally
-

-
90% plasma protein bound
- Plasma t 112 → 6- 8 hrs .

Adverse effects :
-

Dispepsia
-
Caution in Peptic ulcer patients
- Rashes &
Hypersensitivity ( Rare )

(
Iii ,
Peg loticase :
(
Drugs increasing metabolism )

Recombinant urate oxidase for refractory

enzyme
• -

Metabolizes
gout .

• Uric acid to Allan to in

A
1 Plasma Uric Acid

Side effects
•
:
ii.
Anaphylaxis
Ii , Urticaria .

C
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