| Traditional NSAIDs | Inhibit COX-1 and COX-2 so moderate anti-inflammatory but cause GI toxicity & Platelet dysfunction |
| Selective COX-2 Inhibitors | Inhibits COX-2 selectively no GI symptoms & no Platelet dysfunction so use in patients with thrombocytopenia |
| Aspirin | prevents thromboembolic and coronary – vascular diseases |
| Methylprednisolone | anti- inflammatory given IV cause cataracts , osteopenia &- Suppression of adrenal & immunity |
| Gold salts | Do not repair existing damage, but prevent further damage - Taken up by macrophages and suppress phagocytosis and lysosomal enzymes |
| D-Penicillamine | Slow bone destruction and RA progress - Used also in heavy metals toxicity but cause nephritis, aplastic anemia, dermatological problems |
| Sulfasalazine | not be used in pts with G-6-P-D deficiency or sulfa allergy - AEs: mainly on GIT and hemopoitic system & hypersensitivity |
| Hydroxychloroquine | slows progression of erosive bone lesions, and may induce remission - Used in malaria & RA - Causes few AEs: GIT upset, itch, dermatitis, headache, vision blurring |
| Leflunomide | Inhibitor of pyrimidine synthesis and affects T cell proliferation , they effects on bone marrow suppression - AEs: hypertension & severe skin rash , Teratogenic; Not used in women who are pregnant , pts with TB, renal, hepatic or bone marrow impairment |
| Methotrexate | used to treat cancer , Inhibits purine and folic acid ,-Not used in pregnancy & in Pts with renal or hepatic impairments - AEs: mucosal ulceration and nausea, liver cirrhosis & pneumonia-like syndrome |
| Anakinra | Inhibits proinflammatory and immunomodualtory action of IL-1 which in RA pts, is present in the joints and blood in excessive amounts and damage it |
| Etanercept | Anti TNF- α Agents Usually combined with methotrexate but cause inflammation at injection site so not give in case of infection |
| Infliximab | Anti TNF- α Agents ↓ progression of structural damage & ↑ physical function of RA pts. Used for Crohn disease Usually combined with methotrexate - AEs: fever, infections, itch |
| Adalimumab | ↓ RA signs and symptoms & ↓ progression of structural damage - AEs: headache, nausea, rash & local reaction at injection site |
