RHEU

RHEUMATOID MATOI
ARTHRITIS D
ARTH
RITIS
Aim : To treat Acute Flares and Long term management of RA
Acute Flarz
-

· Mild to Moderate : NSAIDs like

Aspirin, Diclofenac , Celecoxib
· Patient does not
respond : Steroids abz used [S2V2zz]
· I-2
joints involved : Intra-articular triamcinolone
· >2
joints : Oral prednisolone
term Management
Long
Treatment of Rheumatoid Arthritis: -

DOL METHOTREXATE
2-4 works for Antiinflammatory effect
Requires
* STEROIDS for 2 to 4 weeks
given
-

*
Inadequate to mothotrexate after 3-6 Months , Addi
response -

① HYDROXYIHLOROQUINE + SULFASALAZINE
② ABATACEPT
③ BIOLOGOCIAL DMARDs
* If no
response change to another
Biological or JBK inhibitor

BRARDS Disease Modifying Anticheumatic Brug

① Conventional AMADS
1) METHOTREXATE
Mos & Blocks dihydrofolate reductase
Cause
: Decreases tetrahydrofolate and
blocks purine synthesis. Lymphocytic toxicity
② Increase in Adenosine : Anti
Inflammatoryaffect
Cause Hepatic Fibrosis
S/E· Hepatotoxicity Liver Cirrhosis (ALT/AST should be monitored
I
every
3-6M
·
Nephrotoxicity Crystalluria
,

· Bor marrow
suppression
2) HYDROXYCHIOROQUINE
MOA
① Blocks
Lymphocyte proliferation
② Stabilizes Lysosomes