This document provides information on antirheumatic drugs used to treat rheumatoid arthritis (RA). It describes the pathophysiology of RA involving inflammatory cytokines like TNF, IL-6, IL-1. NSAIDs provide initial symptomatic relief but DMARDs like methotrexate, hydroxychloroquine, leflunomide, and sulfasalazine suppress disease progression. Biological DMARDs targeting TNF or non-TNF pathways like abatacept are used when traditional DMARDs are ineffective. The goals of treatment are to reduce symptoms, prevent joint damage, and maintain function. Adverse effects of various drugs are also outlined.
The current presentation include the pharmacotherapy for rheumatoid arthritis. The definition, classification, mechanism of action of drugs, pharmacokinetics, adverse effects, contraindications and uses.
Dr. Jibachha Sah,M.V.Sc( Veterinary pharmacology, TU,Nepal),posted lecturer notes on AUTONOMIC AND SYSTEMIC PHARMACOLOGY for B.V.Sc & A.H. 6 th semester veterinary students of College of veterinary science,Nepal Polytechnique Institute, Bharatpur, Bhojard, Chitwan, Nepal.I hope this lecture notes may be beneficial for other Nepalese veterinary students. Please send your comment and suggestion .Email:jibachhashah@gmail.com,moble,00977-9845024121
The current presentation include the pharmacotherapy for rheumatoid arthritis. The definition, classification, mechanism of action of drugs, pharmacokinetics, adverse effects, contraindications and uses.
Dr. Jibachha Sah,M.V.Sc( Veterinary pharmacology, TU,Nepal),posted lecturer notes on AUTONOMIC AND SYSTEMIC PHARMACOLOGY for B.V.Sc & A.H. 6 th semester veterinary students of College of veterinary science,Nepal Polytechnique Institute, Bharatpur, Bhojard, Chitwan, Nepal.I hope this lecture notes may be beneficial for other Nepalese veterinary students. Please send your comment and suggestion .Email:jibachhashah@gmail.com,moble,00977-9845024121
Liquid oral topic in Industrial Pharmacy contains many topics like solution, elixirs, syrups, emulsion, and suspension. This topic includes general introduction, types, formulation, components, uses, and Quality control tests. These are also beneficial in other subjects like Pharmaceutics.
Please follow me for more knowledgeable slides related to pharmacy
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Overview of Discussion-
Anti-rheumatoid drugs
Classification of anti-rheumatoid drugs
Pharmacology of disease modifying anti-rheumatic drugs (DMARDs)
Pharmacology of adjuvant drugs
Malignancy is most familiar as a characterization of cancer.Chemotherapy is a category of cancer treatment that uses one or more anti-cancer drugs as part of a standardized chemotherapy regimen
Liquid oral topic in Industrial Pharmacy contains many topics like solution, elixirs, syrups, emulsion, and suspension. This topic includes general introduction, types, formulation, components, uses, and Quality control tests. These are also beneficial in other subjects like Pharmaceutics.
Please follow me for more knowledgeable slides related to pharmacy
https://www.slideshare.net/studypharm/fluconazole-255463483L
My youtube channel:- Pharma Masti
Overview of Discussion-
Anti-rheumatoid drugs
Classification of anti-rheumatoid drugs
Pharmacology of disease modifying anti-rheumatic drugs (DMARDs)
Pharmacology of adjuvant drugs
Malignancy is most familiar as a characterization of cancer.Chemotherapy is a category of cancer treatment that uses one or more anti-cancer drugs as part of a standardized chemotherapy regimen
an overall overview in corticosteroids and its application in oral and maxillofacial diagnostic medicine and pathology drawing to the conclusions of the limitations and drawbacks of these medicines. i have also included the precautions to be taken in dental therapeutic procedures fo
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
2. Learning Outcomes…
• Describe the pathophysiology of rheumatoid arthritis
• Describe the goal of therapy in rheumatoid arthritis
• Classify the drugs used in rheumatoid arthritis
• Describe the pharmacodynamics and pharmacokinetics of Disease
Modifying Antirheumatic Drugs (DMARDs)
• Describe the role of Biological Disease Modifying Antirheumatic drugs
3. Rheumatoid arthritis
• Rheumatoid arthritis (RA) is an autoimmune disease in which there is:
joint inflammation
synovial proliferation
destruction of articular cartilage
• It is a chronic progressive, crippling disorder with a waxing and
waning course
4. Features of RA
• Tender, warm, swollen joints
• Symmetrical pattern of affected joints
• Joint inflammation often affecting the wrist and finger joints closest to the
hand
• Joint inflammation sometimes affecting other joints, including the neck,
shoulders, elbows, hips, knees, ankles, and feet
• Fatigue, occasional fevers, a general sense of not feeling well
• Pain and stiffness lasting for more than 30 minutes in the morning or after
a long rest
• Symptoms that last for many years
• Variability of symptoms among people with the disease
5. Pathophysiology of RA
• Synovitis in RA is triggered when chemoattractants
produced in the joint recruit circulating inflammatory
cells.
• These inflammatory cells secrete lysosomal enzymes
which damage cartilage and erode bone, while PGs
produced in the process cause vasodilatation and pain.
• Overproduction of tumour necrosis factors (TNF) is a key
inflammatory element in RA
• Interleukin-6 and interleukin-1 are also involved
Key cytokines
involved in
RA:
• TNF
• IL-6
• IL-1
8. Diagnosis
• Medical history.
• Physical examination.
Other lab tests:
a blood test for anemia, which is
common in rheumatoid arthritis.
ESR (erythrocyte sedimentation
rate) which measures
inflammation in the body.
C-reactive protein is useful in
making a diagnosis
Laboratory tests:
Rheumatoid factor (RF)
Anti-CCP antibodies
10. Goal of therapy
• The goals of drug therapy in RA are:
Ameliorate pain, swelling and joint stiffness
Prevent articular cartilage damage and bony erosions
Prevent deformity and preserve joint function
NSAIDs are the first line drugs and afford symptomatic relief in pain,
swelling, morning stiffness, immobility, but do not arrest the disease
process
11. NSAIDs
• Non-steroidal anti-inflammatory drugs
• NSAIDs are a large class of medications useful against pain and
inflammation.
• Most NSAIDs act as nonselective inhibitors of the enzyme
cyclooxygenase (COX), inhibiting both the cyclooxygenase-1 (COX-1)
and cyclooxygenase-2 (COX-2) isoenzymes. COX catalyzes the
formation of prostaglandins and thromboxane from arachidonic
acid.
14. NSAIDs
• NSAIDs can cause stomach irritation or, less often, can affect kidney
function.
• Many other drugs cannot be taken when a patient is being treated
with NSAIDs because they alter the way the body uses or eliminates
these other drugs.
• NSAIDs sometimes are associated with serious gastrointestinal
problems, including ulcers, bleeding, and perforation of the stomach
or intestine.
• People over age 65 and those with any history of ulcers or
gastrointestinal bleeding should use NSAIDs with caution.
15. Antirheumatic drugs
Suppress the rheumatoid process
Bring about a remission
Retard disease progression
But do not have nonspecific antiinflammatory or analgesic action.
• They are used in rheumatoid arthritis (RA) in addition to NSAIDs and
are also referred to as disease modifying antirheumatic drugs
(DMARDs)
Take a few weeks or
months to have an
effect
17. Methotrexate (Mtx)
• Mtx is a dihydrofolate reductase inhibitor
• It has prominent immunosuppressant and antiinflammatory property
• Beneficial effects in RA is due to inhibition of cytokine production,
chemotaxis and cell-mediated immune reaction
• It is administered once weekly
• In RA, Mtx dose is much lower (7.5 – 15 mg) than those needed in
cancer chemotherapy
• Response occurs within 3 to 6 weeks of therapy
Mtx - DMARD of first
choice
18. Methotrexate
• Oral bioavailability of Mtx is variable and may be affected by food.
• Excretion of Mtx is decreased in renal disease: not recommended for
patients of renal disease
• Probenecid and aspirin increase Mtx levels and toxicity.
• Trimethoprim (dihydrofolate reductase inhibitor) can add to inhibition
of dihydrofolate reductase
19. Adverse effects of Methotrexate
• Common adverse effects:
mucosal ulceration and nausea
• Bone marrow suppression
• Cytopenias, cirrhosis of liver and
acute pneumonia like syndrome
may occur with chronic
administration
• Methotrexate is contraindicated
in pregnancy
Recommendations:
• Periodic liver function testing
• Complete blood counts
• Monitoring signs of infection
Supplementation with folic acid or
leucovorin may improve
tolerability
20. Hydroxychloroquine
• Antimalarial drug which induces
remission in upto 50% patients
of RA
• Used for early, mild RA
• May be combined with MTx
• Hydroxychloroquine has less
adverse effects on the liver and
immune system than other
DMARDs
• It may cause ocular toxicity,
irreversible retinal damage and
corneal deposits
• Advantage is relatively low toxicity, but
efficacy is also low
• Onset of effect takes 6 weeks to 6
months
Mechanism of actions:
Reduce monocyte IL–I, consequently
inhibiting B lymphocytes.
Antigen processing may be interfered
with.
Lysosomal stabilization and free radical
scavenging are the other proposed
mechanisms.
21. Leflunomide
• It is an immunomodulator
• Inhibits proliferation of stimulated lymphocytes in patients with
active RA.
• Arthritic symptoms are suppressed and radiological progression of
disease is retarded
• Onset of benefit is as fast (4 weeks).
22. Leflunomide
• Rapidly converted in the body to
an active metabolite which is a
reversible inhibitor of
dihydroorotate dehydrogenase
(DHODH)
• DHODH is an enzyme necessary
for pyrimidine synthesis
• Active metabolite has a long t½
(2–3 weeks)
23. Leflunomide
Adverse effects:
Diarrhoea, headache, nausea
(common)
Weight loss, allergic reactions,
flu-like syndrome, alopecia,
hypokalemia
• Not recommended in liver
disease as it is hepatotoxic
• Contraindicated in pregnancy
• Can be used alone or in
combination with Mtx
Monitor:
Signs of infections
CBC
Electrolytes
Liver enzymes
24. Sulfasalazine
• Compound of sulfapyridine and 5-amino salicylic acid (5-ASA);
• Sulfapyridine is the active moiety in RA.
• It is split off in the colon by bacterial action and absorbed systemically
(contrast ulcerative colitis, in which 5-ASA acting locally in the colon is
the active component)
• Generation of superoxide radicals and cytokine elaboration by
inflammatory cells may be suppressed.
• It is used as a second line drug for milder cases or is combined with
Mtx.
Side effects: GI adverse effects (nausea, vomiting, anorexia) and leukopenia
Onset of activity –
1 to 3 months
25. Biological DMARDs
• Biologic DMARDs are used when there is inadequate response to
traditional DMARDs
• Clinical response is seen within 2 weeks of therapy
• TNF-α inhibitors or non-TNF inhibitors can be used
• Patients on biological DMARDs are at an increased risk of infections
like tuberculosis, fungal infections and sepsis
• Live vaccines cannot be administered in patients taking biologic
DMARDs
27. Biological DMARDs
Adalimumab
• Recombinant monoclonal antibody
• Binds to TNF and interferes with its
activity
• Given subcutaneously weekly or on
alternate weeks
• S/E: headache, nausea,
agranulocytosis, rash, injection site
reaction, increased risk of infection
Certolizumab pegol
• Humanized monoclonal antibody
• Binds to TNF
• Combined with polyethylene glycol
• Given subcutaneously every 2
weeks
• S/E: Similar to other TNF inhibitors
28. Biological DMARDs
Etanercept
• Fusion protein
• Binds to TNF and blocks its
interaction with cell surface
receptors
• Given subcutaneously once a
week
• Combination with Mtx improves
function and achieves remission
in RA
Infliximab
• Chimeric monoclonal antibody
• Binds to TNF and inhibits binding
with its receptors
• Given as iv infusion every 8
weeks
• Infusion related reactions can
occur
• Not indicated for monotherapy
due to development of anti-
infliximab antibodies
29. Biological DMARDs
Abatacept
• Recombinant fusion protein and
costimulation modulator
• Competes with CD28 for binding on
CD80/CD86 protein
• Prevents full T-cell activation and
thus reduces inflammation
• Given as iv infusion every 4 weeks
• S/E: infusion relation reaction,
hadache, upper respiratory
infections, nausea
Rituximab
• Chimeric monoclonal antibody
• Binds with CD20 on surface of
normal and malignant B cells
• Results in B cell depletion
• Given as iv infusion every 16-24
weeks
• Methylprednisolone is given 30
mins prior to infusion to decrease
infusion reactions
30. Biological DMARDs
Tocilizumab and Sarilumab:
• They are monoclonal antibodies that bindto IL-6 receptors
• They inhibit activity of the pro-inflammatory cytokine IL-6
• Given as subcutaneous injection every 2 weeks
31. Glucocorticoids
• They are potent anti-inflammatory drugs used in RA to:
Provide symptomatic relief
Bridge the time until other DMARDs become effective
• Glucocorticoids should always be used at the lowest dose and for the
shortest duration possible
32. Glucocorticoids
• Used in all stages of RA, along with first line or second line drugs
…….Can be given orally or intra-articularly
• Symptomatic relief is marked but they don’t arrest the rheumatoid
process
• Long term use of corticosteroids carries serious disadvantages
33. Therapy with DMARDs
Monotherapy may be initiated with any of the traditional DMARDs
Methotrexate is generally preferred
For patients with inadequate response to monotherapy,
Combination of traditional DMARDs, or use of a TNF inhibitor or non-TNF
biological agent may be needed
• NSAIDs and glucocorticoids can also be used
Early intervention with
DMARDs improves outcome
34.
35. Azathioprine
• Immunosupressive agents….used mostly in kidney transplant rejection
prophylaxis
• Also useful in autoimmune conditions such as RA
• Purine synthase inhibitor
• Converted to 6-MP …. Chemical analog of purine: adenine, guanine,
hypoxanthine
• MOA: suppresses CMI
Affects differentiation and function of T-cells and natural killer cells
36. Cyclosporine
• Inhibits interleukin-1 and interleukin-2 receptor production and
secondarily inhibits macrophage–T-cell interaction and T-cell
responsiveness
• First used in organ transplantation to prevent rejection.
• It is used in patients who have not responded to other drugs.
• Grapefruit juice increases cyclosporine bioavailability by 62%.
• It is metabolized by CYP3A and consequently is subject to a large number
of drug interactions
• Side effects: Bleeding, tender, or enlarged gums; high blood pressure;
increase in hair growth; kidney problems; trembling and shaking of hands.
37. Anakinra
• A recombinant nonglycosylated form of the human IL-1 receptor
antagonist (IL-1ra).
• occupies the IL-1 receptor without triggering it and prevents receptor
binding of IL-1.
• A significant response was observed in approximately 40% of
patients with RA.
• The risk of infection, primarily bacterial, appears to be increased.
Serious infections occurred in 2.1percent patients receiving anakinra
38. Gold salts (Gold sodium thiomalate)
• Proposed mechanism: inhibits macrophage activation.
• Side effects: Redness or soreness of tongue; swelling or bleeding
gums; skin rash or itching; ulcers or sores on lips, mouth, or throat;
irritation on tongue. Joint pain may occur for 1 or 2 days after
injection.
• Gold injections have been used in the treatment of RA for close to
century-initially intramuscular and, more recently, orally.
• With advent of newer agents, gold is rarely used in most part of
world.
40. References
• Lippincott Illustrated Reviews: Pharmacology(6th ed.). Philadelphia,
PA: Wolters Kluwer.
• Clinical Medicine: A Textbook for Medical Students & Kumar PJ
and Clark ML (8th ed.); Elsevier Saunders
• Disease-Modifying Anti-Rheumatic Drugs (DMARDs) used for
Rheumatoid Arthritis- A review. Indian Journal of Basic and Applied
Medical Research; June 2015: Vol.-4, Issue- 3, P. 272-288
• Managing the drug treatment of rheumatoid arthritis. Australian
prescriber. VOLUME 40 : NUMBER 2 page 51-58 : APRIL 2017
Editor's Notes
Combination regimens of 2 or 3 DMARDs include Mtx
Efficacy of sulfasalazine in RA is modest
Infusion related reaction – fever, chills, pruritus, urticaria
Infliximab is used in combination with Mtx
T-lymphocytes need 2 interaction to become activated: 1. antigen-presenting cell must interact with T-cell…2. CD80/CD86 protein on antigen-presenting cell must interact with CD28 protein on T cell