Arthritis Meds

• cDMARDs: Methotrexate MOA

  • For RA → uncertain, exhibits anti-inflammatory effects, thought to inhibit the proliferation and activity of T cells and B cells and decrease cytokine production
  • In cancer → an antimetabolite that interferes w/ DNA synthesis, repair, and cellular replication by inhibiting the enzyme dihydrofolate reductase (folic acid antagonist) which leads to anti-inflammatory effects by decreasing pro-inflammatory mediators and decreasing cellular proliferation
• cDMARDs: Methotrexate

  • Watch for bone marrow suppression, megaloblastic anemia, alopecia, mucositis, supplementation w/ folic acid can help minimize adverse effects
  • Contraindicated in alcoholism, chronic liver disease, pregnancy, breastfeeding, pre existing blood dyscrasias (bone marrow hypoplasia, leukopenia, thrombocytopenia, significant anemia), hypersensitivity, immunodeficiency syndromes
  • Oral, subcutaneous, IM, IV
  • Mainstay of treatment in patients with RA or psoriatic arthritis, also used for treatment of Crohn’s disease, cancer, and psoriasis
• cDMARDs: Hydroxychloroquine

  • MOA unknown, exhibits anti-inflammatory and immunomodulatory effects
  • Ocular toxicity (irreversible retinal damage and corneal deposits), CNS disturbances, GI upset, skin discoloration
  • Used in early RA, may be combined w/ methotrexate, also used for tx of lupus and malaria
• TNF-alpha inhibitors

  • Immunomodulating agents that exert their effects by binding to and inactivating TNF-alpha (a proinflammatory cytokine)
  • Increased risk for pancytopenia, lymphoma, or other cancers, can worsen heart failure, 
  • Live vaccines should not be administered
  • Increased risk for infections, some progressing to serious infections leading to hospitalization or death (bacterial sepsis, TB, invasive fungal, legionella listeria)
  • Can be monotherapy or in conjunction w/ cDMARD for RA, clinical response seen within 2 weeks
• What meds are available for Rheumatoid arthritis

  DMARDs

  • Methotrexate
  • Hydroxychloroquine

  TNF-alpha inhibitors

  • Adalimumab, Certolizumab, Etanercept, Golimumab, Infliximab