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Anti-rheumatic Drugs (Rheumatoid Arthritis (Biological DMARD…

- - - - Suppression of T cell responses, decreases chemotaxis
        Inhibition of DNA and RNA synthesis
    - - Inhibits AICAR transformylase
        Inhibits thymidylate synthetase
        Inhibits dihydrofolate reductase
        Increase in extracellular adenosine level
        Anti‐proliferative effects on T cells and inhibition of macrophage functions
        Decrease in pro‐inflammatory cytokines, adhesion molecules, chemotaxis and phagocytosis
  - - - For RA patients who do not respond well with DMARD therapies
        In combination with MTX for optimal effects. MTX also prevents human anti‐chimeric antibody (HACA) production, ie antibody to drug
- - - - binds to tubulin
        
        prevent tubulin polymerization into microtubules
        
        inhibits leukocyte migration and phagocytosis
        
        inhibits leukotriene B4 and prostaglandin productions
      - Relieve pain and inflammation in acute gouty attack in 12‐24 hours
  - - - Probenecid
        
        ‐inhibits anion transport sites at the proximal tubule
        ‐inhibits uric acid re‐absorption
        ‐increases uric acid excretion
        
        Indications:
        ‐when allopurinol is contraindicated
        in tophaceous gout,
        ‐in increasingly frequent gouty attack, ‐start at 2‐3 weeks after an acute attack
    - - Allopurinol
        
        Decrease uric acid production by inhibiting xanthine oxidase. Xanthine oxidase catalyze the oxidation of hypoxanthine to xanthine and can further catalyze the oxidation of xanthine to uric acid (both steps)