Rheumatoid arthritis treatment options - common disease-modifying antirheumatic drugs (DMARDs)
What csDMARDs are
- csDMARDs - conventional synthetic disease-modifying antirheumatic drugs
- Defined by slowing radiographic progression, not by symptom relief
- Onset is slow (6-12 weeks) - hence bridging glucocorticoid whenever one is started or changed
| Drug | Mechanism |
|---|---|
| Methotrexate | Folate antagonist; anti-inflammatory effect is via adenosine release, not antifolate cytotoxicity |
| Leflunomide | Inhibits dihydroorotate dehydrogenase (DHODH) -> blocks de novo pyrimidine synthesis -> arrests activated T cells (which need an 8-16x increase in pyrimidine supply) |
| Sulfasalazine | Sulfapyridine + 5-ASA; mechanism uncertain |
| Hydroxychloroquine | Raises lysosomal pH, blocks antigen processing and TLR7/9 signalling |
| Gold, penicillamine, azathioprine, ciclosporin | Largely historical in RA |
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