Comprehensive Overview on Disease-Modifying Antirheumatic Drugs (DMARDs)

Disease-Modifying Antirheumatic Drugs (DMARDs)

Introduction to DMARDs

Definition: DMARDs are a class of medications used to treat autoimmune conditions, particularly rheumatoid arthritis, by slowing disease progression.
Types: Conventional synthetic (csDMARDs), Biologic (bDMARDs), and Targeted synthetic (tsDMARDs).

Key DMARDs Covered

d-Penicillamine (csDMARD)
Methotrexate (csDMARD)
Infliximab (bDMARD)

d-Penicillamine - Mechanism of Action

Chelates heavy metals (used in Wilson's disease)
Suppresses T-cell activity and decreases rheumatoid factor production
Inhibits collagen cross-linking

d-Penicillamine - Indications

Rheumatoid arthritis (when other DMARDs are ineffective)
Wilson's disease (primary indication)
Cystinuria

d-Penicillamine - Adverse Effects

Bone marrow suppression
Proteinuria and nephrotic syndrome
Rash, fever
Autoimmune syndromes (e.g., myasthenia gravis)

d-Penicillamine - Drug Interactions

Antacids reduce absorption
May enhance toxicity of digoxin
Increased risk of hematologic toxicity with other immunosuppressants

Methotrexate - Mechanism of Action

Inhibits dihydrofolate reductase
Decreases synthesis of DNA, RNA, thymidylates, and proteins
Anti-inflammatory via increased adenosine levels

Methotrexate - Indications

First-line treatment for rheumatoid arthritis
Psoriasis
Certain cancers (at higher doses)

Methotrexate - Adverse Effects

Hepatotoxicity
Bone marrow suppression
Pulmonary fibrosis
Gastrointestinal upset

Methotrexate - Drug Interactions

NSAIDs may increase toxicity
Trimethoprim increases risk of marrow suppression
Folic acid reduces side effects (often co-prescribed)

Infliximab - Mechanism of Action

Monoclonal antibody against TNF-alpha
Neutralizes TNF-alpha, reducing inflammation and immune response

Infliximab - Indications

Rheumatoid arthritis (in combination with methotrexate)
Crohn’s disease, ulcerative colitis
Ankylosing spondylitis
Psoriatic arthritis

Infliximab - Adverse Effects

Infusion reactions
Increased risk of infections (e.g., TB, fungal)
Reactivation of hepatitis B
Autoantibody formation

Infliximab - Drug Interactions

Live vaccines contraindicated during treatment
Increased immunosuppression with other biologics or immunosuppressants

Visual Aids and Case Study Discussion

Diagrams of mechanisms (e.g., TNF-alpha pathway, folate pathway)
Flowchart comparing side effects
Patient case scenarios for practical understanding

Presentation for Disease-Modifying Antirheumatic Drugs (DMARDs)

END OF THE CHAPTER

Owner

Hi. I’m Writer of Researchsop.com. ’ ’ Please share these SOPs to all concern pharma people for their development. I like to fullfill the need of curious people. These things inspire me to make things looks better.