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Slow-acting anti rheumatic drugs (SAARDs) are drugs thatchange the progression of the disease (Disease modifying arthritis drugs, DMARDs)

Slow- acting anti rheumatic drugs (Slow- acting anti rheumatic drugs, SAARDs)(Slow-acting anti rheumatic drugs, SAARDs) are drugs thatchange the progression of the disease (Disease modifying arthritis drugs, DMARDs)

01 and chemical synthesis (DMARDs) 01 and chemical synthesis (DMARDs) and chemical synthesis (DMARDs)

 

1.

1.

Mechanism of action Mechanism of action : as a dihydrofolate reductase inhibitor, inhibit lymphocyte proliferation and inflammation

Indications and indications : Methotrexate can significantly improve all clinical disease variables, such as joint swelling, tenderness, joint function status and inflammatory reactants, etc.

Adverse reactions (ADR) adverse reactions (ADR) : digestive symptoms, nausea, mouth sores, alopecia, liver damage, bone marrow suppression

2.

2.

Mechanism of action : Cyclophosphamide is a cycle non-specific drug, which is inactive in vitro.

Indications Indications : nephrotic syndrome, lupus nephritis, psoriatic arthritis and the like

Adverse reaction Adverse reactions : bone marrow suppression, hair loss, digestive tract, stomatitis, cystitis

 

3.

3.

Mechanism of action Mechanism of action : The hydrolyzed product is mycophenolic acid (MPA), which has immunosuppressive activity

Indications Indications : autoimmune diseases such as pemphigus, bullous pemphigoid, systemic lupus erythematosus (SLE), lupus nephritis and psoriasis, intestinal Behcet's disease and the like

Adverse reactions: Adverse reactions: varicella - zoster virus infection , gastrointestinal reactions
.

Infect

 

4.
Sulfasalazine (SASP) commonly used in sulfa antibiotics  

4.
sulfa antibiotics 4.
sulfa antibiotics antibiotics commonly sulfasalazine (the SASP)   

Mechanism of action : Sulfasalazine is decomposed into 5-aminosalicylic acid in the intestine to play an anti-inflammatory and immunosuppressive effect
.

Mechanism of action Mechanism of action : Sulfasalazine is decomposed into 5-aminosalicylic acid in the intestine to play an anti-inflammatory and immunosuppressive effect
.

Indications : Relieve inflammation
.
It has a good effect on inflammation of peripheral joint attachment ends and ulcerative colitis , but the effect on spinal diseases is uncertain
.

Indications Indications : relieve inflammation
.
It has a good effect on inflammation of peripheral joint attachment ends and ulcerative colitis , but the effect on spinal diseases is uncertain
.
Ulcerative colitis

Adverse reactions : gastrointestinal symptoms such as nausea, vomiting, diarrhea, headache, dizziness, rash, decrease sperm counts, bone marrow suppression, exfoliative dermatitis
.

Adverse reaction Adverse reactions : gastrointestinal symptoms such as nausea, vomiting, diarrhea, headache, dizziness, rash, decrease sperm counts, bone marrow suppression, exfoliative dermatitis
.

 

 

5.
Hydroxychloroquine (HCQ) is commonly used in antimalarial drugs

5.
Hydroxychloroquine (HCQ) is commonly used in antimalarials 5.
Hydroxychloroquine (HCQ) is commonly used in antimalarials

Mechanism of action : change the acidic microenvironment in the cell, stabilize the lysosome, inhibit the synthesis of TNF-a, TNFr, reduce the formation of autoantibodies and lymphocyte proliferation
.

Mechanism of action Mechanism of action : change the acidic microenvironment in the cell, stabilize the lysosome, inhibit the synthesis of TNF-a, TNFr, reduce the formation of autoantibodies and lymphocyte proliferation
.

Indications : It is often used in the treatment of mild diseases of early lupus skin involvement or combined with adjuvant therapy
.

Indications and indications : It is often used to treat mild diseases of early lupus skin involvement or combined adjuvant therapy
.

Adverse reactions : be alert to cardiotoxicity, corneal and retina damage
.
Patients can undergo regular eye examinations.
Taking a lot of vitamin C, chondroitin, ammonium chloride, etc.
can promote the excretion of chloroquine and reduce side effects
.
Patients taking hydroxychloroquine can undergo routine check-ups once a year without other high-risk factors
.

Adverse reactions Adverse reactions : be alert to cardiotoxicity, corneal and retina damage
.
Patients can undergo regular eye examinations.
Taking a lot of vitamin C, chondroitin, ammonium chloride, etc.
can promote the excretion of chloroquine and reduce side effects
.
Patients taking hydroxychloroquine can undergo routine check-ups once a year without other high-risk factors
.

6.
Leflunomide (Kefluromide)

6.
Leflunomide (Kefluromide) 6.
Lefluromide (Kefluromide)

Mechanism of action : It is an oxazole derivative that inhibits the activity of dihydrolactate dehydrogenase through competition, thereby inhibiting the biosynthesis of pyrimidine, inhibiting the activity of tyrosine kinase, thereby inhibiting the biological activity of pyrimidine, inhibiting NF-kB, and inhibiting TNFa, The expression of TNFr and IL-1
.

Mechanism of action : It is an oxazole derivative that inhibits the activity of dihydrolactate dehydrogenase through competition, thereby inhibiting the biosynthesis of pyrimidine, inhibiting the activity of tyrosine kinase, thereby inhibiting the biological activity of pyrimidine, inhibiting NF-kB, and inhibiting TNFa, The expression of TNFr and IL-1
.
Mechanism

Indications : It can effectively alleviate disease activity, control disease progression, prevent bone destruction, reduce disability rate, and improve the quality of life of patients
.

Indications Indications : It can effectively alleviate disease activity, control disease progression and prevent bone destruction, reduce morbidity, improve the quality of life for patients
.

Adverse reactions : diarrhea, skin rash, leukopenia, abnormal liver function, high blood pressure
.
It is forbidden to use for pregnancy and pregnant women
.

Adverse reactions Adverse reactions : diarrhea, skin rash, leukopenia, abnormal liver function, hypertension
.
It is forbidden to use for pregnancy and pregnant women
.

7.
Penicillamine

7.
Penicillamine 7.
Penicillamine

Mechanism of action : depolymerize the disulfide bonds of rheumatoid factor, inhibit cross-linking of collagen fibers, and inhibit the function of neutrophils and T cells
.
Play immune suppression and prevent joint destruction
.

Mechanism of action Mechanism of action : depolymerize the disulfide bond of rheumatoid factor, inhibit the cross-linking of collagen fibers, and inhibit the function of neutrophils and T cells
.
Play immune suppression and prevent joint destruction
.

Adverse reactions : nausea and vomiting, oral ulcers, abnormal taste, blood cell reduction, proteinuria, hematuria, myasthenia gravis, and occasional Good pasture syndrome
.

Adverse reactions Adverse reactions : nausea and vomiting, oral ulcers, abnormal taste, blood cell reduction, proteinuria, hematuria, myasthenia gravis, and occasionally Good pasture syndrome
.

8.
Thalidomide (thalidomide)

8.
Thalidomide (Talidomide) 8.
Thalidomide (Talidomide)

Mechanism of action : Inhibit the chemotactic response of leukocytes at the inflammation site, inhibit TNF-α, change the density of leukocyte adhesion molecules mediated by TNF-α, inhibit the phagocytic ability of centriocytes of the lobular nucleus, and inhibit IL-6 and IL-10 And IL-12 production, regulate IFN-γ and increase the secretion of IL-2, IL-4 and IL-5 by immune cells
.

Mechanism of action Mechanism of action : Inhibit the chemotactic response of leukocytes at the inflammation site, inhibit TNF-α, change the density of leukocyte adhesion molecules mediated by TNF-α, inhibit the phagocytic ability of centriocytes of the lobular nucleus, and inhibit IL-6 and IL -10 and IL-12 production, regulate IFN-γ and increase the secretion of IL-2, IL-4 and IL-5 by immune cells
.

Indications : for the treatment of ankylosing spondylitis (AS) systemic lupus erythematosus, rheumatoid arthritis and the like
.

Indications : for the treatment of ankylosing spondylitis (AS) systemic lupus erythematosus, rheumatoid arthritis and the like
.
Indications

Adverse reactions : lethargy, abnormal liver function, decreased blood cells, microscopic hematuria, constipation, peripheral nerve numbness (numbness of hands, feet, mouth and corners)
.
And peripheral neuropathy is irreversible and difficult to recover
.
Have a serious impact on fetal development
.
Contraception is suitable for childbearing age
.

Adverse reactions Adverse reactions : lethargy, abnormal liver function, decreased blood cells, microscopic hematuria, constipation, peripheral nerve numbness (numbness of hands, feet, mouth and corners)
.
And peripheral neuropathy is irreversible and difficult to recover
.
Have a serious impact on fetal development
.
Contraception is suitable for childbearing age
.

02 biological agents

02 biological preparation 02 biological preparation biological preparation

Biological agents (DMARDS) include tumor necrosis factor antagonists, interleukin-6 receptor antagonists and other anti-inflammatory cytokine antagonists, including infliximab, etanercept and Adalimumab , B-cell therapy such as Abatacept
.

Biological agents (DMARDS) include tumor necrosis factor antagonists, interleukin-6 receptor antagonists and other anti-inflammatory cytokine antagonists, including infliximab, etanercept and Adalimumab , B-cell therapy such as Abatacept
.

1.
TNF inhibitor 

1.
TNF inhibitor 1.
TNF inhibitor 

Mechanism of action : TNF-α is the core regulatory factor in the inflammatory response.
It is secreted by immune cells and can transmit survival and apoptosis signals into the cells
.
TNF-α inhibitors block the biological activity of TNF-α through specific binding to TNF-α, thereby blocking the binding of inflammatory factors to the receptor
.
To achieve the purpose of breaking the vicious inflammatory cycle of RA and continuing to alleviate the condition
.

Mechanism of action Mechanism of action : TNF-α is the core regulator in the inflammatory response.
It is secreted by immune cells and can transmit survival and apoptosis signals into cells
.
TNF-α inhibitors block the biological activity of TNF-α through specific binding to TNF-α, thereby blocking the binding of inflammatory factors to the receptor
.
To achieve the purpose of breaking the vicious inflammatory cycle of RA and continuing to alleviate the condition
.

Indications : This type of drug has the effects of rapid anti-inflammatory and control of disease activity in RA patients, preventing bone destruction and alleviating the disease
.

Indications : This type of drug has the effects of rapid anti-inflammatory and control of disease activity in RA patients, preventing bone destruction and alleviating the disease
.
Indications

Adverse reactions: It is expensive and may develop drug resistance, increasing the risk of infection, especially the recurrence of opportunistic fungal infections and latent tuberculosis
.

Adverse reactions: It is expensive and may develop drug resistance, increasing the risk of infection, especially the recurrence of opportunistic fungal infections and latent tuberculosis
.
Adverse reactions:

2.
Interleukin-6 receptor antagonist

2.
Interleukin-6 receptor antagonist 2.
Interleukin-6 receptor antagonist

Tocilizumab is a human-derived IgG1 monoclonal antibody that binds to the soluble and membrane-bound 80KDa component of IL-6R with high affinity, and inhibits IL-6-mediated IL-6 in cells that structurally express IL-6R Interaction
.
For those with poor efficacy in chemical DMARDS
.

Tocilizumab tocilizumab tocilizumab tocilizumab one human-derived IgG1 mAb, soluble and membrane-bound forms of IL-6R with high affinity component of 80KDa, which inhibits the constitutively expressed IL IL-6R cells -6 mediated interaction
.
For those with poor efficacy in chemical DMARDS
.

3.
Janus kinase (JAK) inhibitor tofacitib 

3.
Janus kinase (JAK) inhibitor tofacitib 3.
Janus kinase (JAK) inhibitor tofacitib 

Mechanism of action : As a targeted synthetic drug, it can prevent the activation and phosphorylation of signal transducers and activators of transcription (STATs) that regulate gene expression and other cellular activities
.

Mechanism of action : As a targeted synthetic drug, its mechanism of action can prevent the activation and phosphorylation of signal transducers and activators of transcription (STATs) that regulate gene expression and other cellular activities
.

Indications : Tofacitinib is an oral drug that can be used to treat moderate to severely active adult RA patients with poor efficacy on methotrexate.
It can be used as a single agent or combined with methotrexate or other non- Combined use of biological DMARDS
.

Indications Indications : cloth-Tropsch process for an oral drug used to treat poor efficacy of methotrexate to severe active RA patients with adult, either as a single agent, or may be with methotrexate Use in combination with other non-biological DMARDS
.

Adverse reactions : diarrhea, serum total cholesterol and lipoprotein level rise
.
In addition, there are reports in the literature that these drugs have a certain risk of promoting thrombosis , leading to serious adverse reactions such as pulmonary embolism
.

Adverse reactions adverse reactions : diarrhea, serum total cholesterol and lipoprotein level rise
.
In addition, there are reports in the literature that these drugs have a certain risk of promoting thrombosis , leading to serious adverse reactions such as pulmonary embolism
.
Cholesterol Thrombosis

03Chinese medicine preparations

03 Chinese medicine preparation 03 Chinese medicine preparation Chinese medicine preparation

Triptolide (Tripterguim Wilfordihookf)

Tripterygium triptolide (Tripterguim Wilfordihookf) (Tripterguim Wilfordihookf)

Mechanism of action : Tripterygium wilfordii polyglycosides (TG) is the main active ingredient of Tripterygium wilfordii.
TG can up-regulate the levels of interleukin-10 (IL-10), CD4+ and CD25+ regulatory T cells (Treg0), and increase the fork head transcription factor ( FoxP3) expression, down-regulate tumor necrosis factor-α (TNF-α), endothelin-19ET-10 levels and so on
.

Mechanism of action : The main active ingredient of Tripterygium wilfordii is Tripterygium wilfordii polyglycosides (TG).
TG can up-regulate the levels of interleukin-10 (IL-10), CD4+ and CD25+ regulatory T cells (Treg0), and increase fork-head transcription Factor (FoxP3) expression, down-regulate tumor necrosis factor-α (TNF-α), endothelin-19ET-10 levels and so on
.

The treatment effect is better for moderate patients
.
Sinomenine (sin), total glucosides of paeony, etc.
are analogues of chemokines that affect the expression of regulatory T cells and exert anti-inflammatory effects
.

The treatment effect is better for moderate patients
.
Sinomenine (sin), total glucosides of paeony, etc.
are analogues of chemokines that affect the expression of regulatory T cells and exert anti-inflammatory effects
.

Indications : rheumatoid arthritis, systemic lupus erythematosus, psoriasis and the like
.

Indications Indications : rheumatoid arthritis, systemic lupus erythematosus, psoriasis and the like
.

Adverse reactions : It has an impact on the reproductive system of men and women, men's sperm count declines, lack of mobility, women's irregular menstruation, and menstruation
.
Affect liver and kidney function, skin rash, itching, blood cell reduction, asthma patients, patients with aplastic anemia, use with caution
.

Adverse reactions Adverse reactions : affect the reproductive system of men and women, men's sperm count declines, lack of mobility, women's irregular menstruation, and menopause
.
Affect liver and kidney function, skin rash, itching, blood cell reduction, asthma patients, patients with aplastic anemia, use with caution
.


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