Disease Modifying Anti-Rheumatic Drugs

• Have been shown to reduce radiographic progression (erosions)

 Disease-Modifying Antirheumatic Drugs
Nonbiologic DMARDs

Name Target of Activity

Biologic DMARDs
Azathioprine Purine synthesis; inhibits T-
lymphocyte proliferation Name Target of Activity
Adalimumab TNF-α
D-Penicillamine Unknown
Etanercept TNF-α
Hydroxychloroquine T-lymphocytes?
Infliximab TNF-α

Leflunomide Pyridine synthesis Abatacept CD28

Anakinra IL-1
Methotrexate Dihydrofolate reductase; folate
metabolism Rituximab CD20

Sulfasalazine Uncertain; multifactorial, Tocilizumab IL-6 receptor

including impairment of lymphocyte
function and cytokine synthesis IVIG* Fc receptors
Tetrahydrofolate is an important cofactor in the
production of purines transferring a carbon atom.
Salicylate Sulfinpyradone
Monoclonal Antibody
Soluble TNF-Receptors directed
serve against
as a
Engineered Soluble TNF Receptor
TNF-alpha: Infliximab (Remicade ®),
balance to (Enbrel®)
TNF
Etanercept
Adalimumab (Humira®)

TNF

SIGNAL
Rheumatoid Arthritis (RA)
T-Cell
Antigen

Antigen
Presenting CD4 T-Cell
Cell

Immune Reaction
B-Cell Autoantibody
Cytokines
 Auto-
Antigen

B-Cell CD4 T-Cell

Autoantibody B-Cell
 Antibodies
B-Cell Rheumatoid Factor
Plasma Cell
Rituximab: anti-CD-20

CD-20

B-Cell