Title:An Update on Disease Modifying Antirheumatic Drugs
Volume: 13
Issue: 4
Author(s): Poorvashree Joshi and Suneela S. Dhaneshwar
Affiliation:
Keywords:
Arthritis, biological DMARDs, disease modifying antirheumatic drugs, IL-1, non-biologic DMARDs, TNF-α.
Abstract: Disease modifying antirheumatic drugs (DMARDs) is a category of drugs which is used as medication in
various arthritic conditions to arrest the progression of disease along with relief from pain. About 83% of population
worldwide uses DMARDs. Withdrawal of COX-2 inhibitors because of cardiovascular side effects and short-term action
associated with glucocorticoids provided a motivation for development of newer DMARDs. Currently non- biological
DMARDs like methotrexate, sulfasalazine, hydroxychloroquine and azathioprine serve the purpose of relieving pain and
inhibiting the progression of disease. Biological DMARDs like toclizumab, adalimumab, infliximab, golimumab and
abatacept have shown more efficacy and lesser side effects as compared to non- biological DMARDs but their access to
patient is less because of higher cost. DMARDs act by different mechanisms against inflammation like inhibition of tumor
necrosis factor, suppression of IL-1 and TNF-α, induction of apoptosis of inflammatory cells, by increasing chemotactic
factors, inhibition of purine synthesis, pyrimidine metabolism or purine embolism. DMARDs have important applications
in diseases like rheumatoid arthritis, Crohn’s disease, juvenile idiopathic arthritis, psoriatic arthritis and myasthenia
gravis. Present review mainly focuses on DMARDs and their clinical applications giving an overview of their mechanism
of action, pharmacokinetic properties, advantages over conventional therapies, shortcomings and recent trends.
