Question

Tiffany, 36-year-old woman who has been experiencing of pain and swelling in her hands and feet. On examination by her General Practitioner (GP) her hands and feet display evidence of inflammation; rubra, heat and swelling and decreased function. On palpation and movement, they cause considerable pain which she rates as 5 - 7 on pain scale of 0 -10. When questioned on when this pain and inflammation first started, she is unable to say, but it has gradually worsened over the past 4 weeks. She states she has been taking Ibuprofen which initially provided relief but is no longer as effective. It is worse in the morning and she is now unable to carry out her many aspects of her normal routine. Her GP suspect’s Rheumatoid Arthritis (RA).

3c.       Disease Modifying Anti Rheumatic Drugs (DMARD) are often the first line of pharmacological therapy despite the significant side effects. Name two non-biological DMARD’s, describe how they work and why they are prescribed despite the significant adverse drug reactions (ADR’s)                                                                                                 3 marks ( 1 mark for drug names, 2 marks for discussion)

Answer 1

Rheumatoid Arthritis (RA) - it is a autoimmune disorder in which there is joint inflammation synovial proliferation and destruction of articular cartilage

Non Biological DMARDS-

1). Methotrexate

2). Azathioprine

3).Sulfasalazine

4).Chloroquine or Hydroxychloroquine

5).Lefulunomide

Methotrexate - it has immunosuppressant and anti-inflammatory properties. In RA its effect is related to inhibition of cytokine production; chemotaxis and cell mediated immune reaction

AZATHIOPRINE- IT acts by getting converted to 6-mercaptopurine by the enzyme thiopurine methyl transferase(TPMT). In RA it acts by suppressing Cell mediated immunity and inflammation

Other DMARDs like Sulfasalazine and chloroquine mechanism is not well established .

In RA NSAIDS are first line drugs but they only provide symptomatic relief but DMARDs giving symptomatic relief also arrest/slows or modify RA disease progression so despite the adverse effects they are used but DMARDs in mild RA should be compared against side effects