1 / 16

Antirheumatics

This piece provides an in-depth analysis of the treatment options available for rheumatoid arthritis (RA), focusing on various classes of antirheumatics, including nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), glucocorticoids, and biologic treatments such as monoclonal antibodies targeting IL-1 and TNF. It discusses the roles of both short-acting and long-acting medications, their mechanisms, benefits, risks, and the emerging role of chondroprotective agents.

leilani-snyder
Download Presentation

Antirheumatics

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Antirheumatics

  2. Treatment of RA • Antirheumatics • Nonsteroidal antiinflammatory drugs (NSAID) • Slowly acting drugs (DMARD) • Glucocorticoids • Biologic treatment monoclonal antibodies inhibitors of IL-1, TNF (infliximab, adalimumab)

  3. Acidic NSA Derivates ofEnolicAcids Pyrazolons Oxicams phenylbutazone azapropazone piroxicam meloxicam izooxicam Derivates ofCarboxylicAcids salicylic acid acetoacetatic acid antranilinic acid propionic acid ASA diflunizal aloxipyrin indomethacin sulindac diclofenak tolphenamic acid mefenamic acid ibuprofen ketoprofen naproxen Neutral NSA Alkanons Sulfonamides Coxibs nabumetone nimesulid celecoxib rofecoxib valdecoxib Nonsteroidal antiinflammatory drugs (NSAID)

  4. Properties Cyklooxygenase 1 Cyklooxygenase 2 Localisation cytoplasmatic in ER perinuclear Regulation constitutional inducable / constitutional Presence intissues GIT mucosa, renal parenchyma, endothelium, Tr Mf, Mo, CNS, kidneys, uterus, seminiferous Predicted function Integrity of stomach mucosa, kidney perfusion, Tr function Patogenesis of inflammation andgenesis of pain

  5. NSAID Ratio COX 1 / COX 2 Aspirin (ASA) 166 Indomethacin 80 Flurbiprofen 10 Ketoprofen 5,1 Piroxikam 3,3 Ibuprofen 0,9 Naproxen 0,6 Diclofenak 0,5 Meloxicam 0,37 Nimesulid 0,19 Rofecoxib 0,013

  6. Selective inhibitors of COX-1 ASA (doseto 300 mg daily) Nonselective inhibitors of COX-1 and also COX-2 ASA (more than 500 mg/day), ibuprofen, diclofenac, indomethacin Preferential and selective inhibitors of COX-2 Etodolac, nimesulid, meloxicam, celecoxib

  7. NSAID Risk ofGIT bleeding Ibuprofen 2,1 Naproxen 3,1 Diclofenac 3,4 Ketoprofen 5,4 ASA 7,2 Indomethacin 14,4

  8. DMARDs Chloroquine Hydroxichloroquine Sulfasalazine Methotrexate Leflunomid Penicillamine Azathioprine Ciclosporin Infliximab Etanercept Adalimumab

  9. Glucocorticoids Short-acting metylprednisolone Intermediate –acting triamcinolone Long-acting dexametazone

  10. Rapid acting drugs (SYRADOA) Analgetic drugs – paracetamol, metamizol Nonsteroidal antiinflammatory drugs (NSAID) Weak opioids – tramadol Topic transdermal treatment NSAID (diclofenac, ketoprofen) Iritanciá (capsaicin, menthol) Steroid antiflogistic drugs (corticoids) intraarticular(triamcinolone, betametazone) Slowly acting drugs (SYSADOA) Qaulified as chondroprotectives Disease modifying drugs (DMOAD) Glucosaminsulphate Chondroitinsulphate Hyaluronic acid Treatment of OA

  11. Chondroprotective Agents Characteristics ofChondroprotective Agents Chondroprotective Agents Characteristics ofChondroprotective Agents Glucosamine Glucosamine Stimulate chondrocyte and synoviocyte metabolism Stimulate chondrocyte and synoviocyte metabolism Chondroitin sulfate Chondroitin sulfate Inhibit degradative enzymes Inhibit degradative enzymes Chondroitin sulfate Chondroitin sulfate Prevent fibrin thrombi in periarticular tissues Prevent fibrin thrombi in periarticular tissues Chondroprotectives • Drugs improving nutrition of joint cartilage

More Related