What is Rheumatoid Arthritis?
So now we’re looking at the drugs that are used in rheumatoid arthritis now what is rheumatoid arthritis it is basically a chronic multi-system inflammatory autoimmune disease with no known cause it is mainly common in women with childbearing age there are many manifestations of the this autoimmune disease but the main manifestation is rheumatoid arthritis where
There is persistent inflammatory sinusite synovitis of peripheral smaller joints this leads to a mobility and pain and inflammation of course now what causes this as we know it is autoimmune disease so an auto antibody which is basically an igm antibody is produced against the fc portion of the igg antibody all of this it leads to a type 3 and a hypersensitivity
Reaction where this complex of igm and igg it lodges in different places like glomeruli soft tissues joints etc leading to the multi-system inflammatory manifestations now to treat rheumatoid arthritis we basically need to focus on two things there are two aspects to this to this disease if we look look at them closely one is the pain and inflammation that the
Disease causes and this is what what the patient complains about most it is due to the prostaglandins and leukotrienes and all the stuff that are involved in pain and the other is the autoimmune riya action and the further damage that is occurring to the organs due to the autoimmune reaction to combat the pain we know we need to use ns aids and it says also
Have anti-inflammatory actions but they are not really used as any anti as anti-inflammatory because high doses are required and at high doses and acids have a vast variety of side effects including gastritis and bleeding disorders to combat the immune reaction response of the immune system which is mediated by the cytokines for example tnf we use dmards that is
Disease-modifying antirheumatic drugs now the two aspects of treatment we’ll discuss in detail that which drugs we use to combat these two aspects first set of drugs are used to combat the pain and inflammation as stated before and the second class of the drugs the dmards disease-modifying antirheumatic drugs are to decrease the autoimmune response and prevent further
Tissue damage by suppressing the immune system to control pain and inflammation we mainly use ns aids and glucocorticoids of course the dmards further classified as non biologic and biologic but non biologic are not derived from biological sources and barrage achill source biologic are derived from biological sources that is obvious let’s see what ana said’s do for
Rheumatoid arthritis they’re used for rapid symptomatic relief by decreasing inflammation and pain they decrease the stiffness and swelling in the joints they do not have any effect on the progression of the disease now the glucocorticoids act mainly as suppressants of the immune response and also as anti-inflammatory by decreasing leukocyte migration increasing
Lysosome stability decreasing capillary permeability decreasing inflammation and decreasing the release of prostaglandins and leukotrienes expression of cox-2 is inhibited which is mediated a which is a metre which is needed in inflammation intro entirly keynes are also decreased their main side effects are not to be discussed here but they are very they have a
Very wide range of side effects such as candy candy dais is worth thrush let’s discuss the non-biological dmards first the first drug to discuss is methotrexate now what methotrexate does is that it is cytotoxic to the lympus lymphocytes by being d h f that is dihydrofolate reductase inhibitor and folate antagonist it inhibits the bone marrow the lymphocytes and
Thus decreasing the amounts of antibodies produced the side effects are too much it is hepatotoxic hamato toxic because the blood cells are dividing it is a patou toxic so the blood levels need to be monitored and so the liver function need to be monitored as well it causes mucosal ulcers it is contraindicated in pregnancy in liver disease and in peptic ulcer
The side effects can be minimized by administration of folic acid next is hydro chloroquine or chloroquine what it does it is that it stabilizes the lysosomes decreases chemotaxis and scavenge the free radicals they are mainly used in mild disease the side effects include gi distress visual pathology such as corneal or retinal opacity is there so a visit to an
Ophthalmologist once a year is recommended synchronism is seen of course hemolysis is also seen in g6pd deficient patients like aspirin next drug is sulfasalazine it acts firstly it is acted upon by a colonic bacteria which splits into splits it into two active compounds one is cell for paradeen and the other is 5e sa that is aspirin like a style salicylic acid so
Sulfur pyridine what it does is that it inhibits p cell function and production of inflammatory cytokines such as interleukins tnf by monocytes is decreased and aspirin as we know inhibit cox and have local and inflammatory action in ulcerative colitis crohn’s disease etc the side effects include hemolysis leukopenia etc the next drug is leaf luna might how it
Acts is that it inhibits de hydro rotate dehydrogenase thus decreasing the level of ump and thus decreased ribonucleotides formation it basically arrests the lymphocytes at the g1 phase of the cell cycle and thus immunoglobulins that is the auto antibodies are not produced side effects are like the anti-cancer drugs like same as the previous ones alopecia rash and
Diarrhea and it is also hepatotoxic the next drugs are gold compounds all the drugs with oro in it a uro for example or o thio malate now what gold does is that it alters the morphology and function of macrophages which are involved in the cell mediated immunity thus decreases the immune response side effects include hypersensitivity like actions itching stomatitis
Also ulcers proteinuria x’ and rarely aplastic anemia scan be seen the next drug is deep pencil oh my it is basically a pencil in metabolite and it acts by suppressing t cell and it also suppresses the r factor that is responsible for this disease and the side effect includes proteinuria let’s see the biologic team arts now when the patient does not respond to non
Biologic agents we use biologic dmards they have side effects so we reserved we keep them as a reserve the first is at intercept it is a basically a recombinant form of the tnf receptor so it basically acts like a sponge to tnf-alpha and absorbs the tnf you know tnf is involved in all the immune reactions and it is a mediator so if that is inhibited then all the
Opportunity for opportunistic infections like tb can occur next is infliximab and adalimumab it is basically a monoclonal antibody to tnf so it neutralizes tnf side-effects are the same thirdly ana kendra it is basically interleukin 1 receptor antagonist same side effects and lastly a better cept it is cell t cell activation inhibitor same side effects we can see
That all these four drugs have the same side effect of suppressed immunity and thus opportunistic infections are there
Transcribed from video
Pharmacology- Rheumatoid Arthritis- Autocoids Pharma MADE EASY! By Med Made Sirius-ly easy!