Paper I
2023 January (Supplementary) (2019 Scheme) · 100 marks · 180 min

Question

Pharmacotherapy of Rheumatoid arthritis.

Q114 marksShort Answers

Answer

  • NSAIDs (Ibuprofen, Naproxen) — symptomatic relief of pain/inflammation; do not alter disease progression.
  • Disease-modifying antirheumatic drugs (DMARDs) — the anchor of treatment, slowing/halting joint damage:
    • Methotrexate — first-line, anti-inflammatory/immunomodulatory action at low weekly doses (largely via increased adenosine release).
    • Hydroxychloroquine, Sulfasalazine — used alone in mild disease or combined with methotrexate.
    • Biologic DMARDs (Etanercept, Infliximab — anti-TNF-alpha agents; Rituximab — anti-CD20) — used when conventional DMARDs are inadequate.
  • Corticosteroids (low-dose Prednisolone) — rapid symptom control/bridging therapy while DMARDs take effect (which can take weeks to months), or for acute flares.

Principle: early DMARD initiation is standard practice, since irreversible joint damage can occur even in early disease if treatment is delayed.

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