Antirheumatic Agents

Publication Details


The term "antirheumatic drugs" refers to agents used in the therapy of inflammatory arthritis, predominantly rheumatoid arthritis, but also idiopathic juvenile arthritis, psoriatic arthritis, ankylosing spondylitis and others. Aspirin, the nonsteroidal antiinflammatory agents and corticosteroids are used commonly in these conditions, but have little effect in altering the natural history and outcomes of inflammatory arthritis, which can lead to cartilage and joint destruction and severe disability. More important and diverse are the "Disease-Modifying Anti-Rheumatic Drugs" (DMARDs) which are the mainstay of therapy in rheumatoid arthritis and have dramatically altered the outcome of these conditions, and improved the quality of life of patients with rheumatoid arthritis.

The initial DMARDs were the gold preparations which were first used in the 1930s. More potent and better tolerated agents followed in the 1950s and 1960s, including methotrexate, hydroxychloroquine, sulfasalazine, penicillamine, azathioprine and the thiopurines. More modern DMARDs have included potent, small molecule immunosuppressive agents such as leflunomide, cyclosporine, tacrolimus and mycophenolate. More recently, monoclonal antibodies and biologics have been developed that act on the primary cytokines and inflammatory pathways that are active and play a major role in rheumatoid arthritis. These important agents include the tumor necrosis factor antagonists, anticytokines (such as anakinra) and other major immunosuppressive agents (rituximab, abatacept, and tocilizumab). Agents used predominantly as antirheumatic drugs are listed below with specific links to the individual drugs. Medications for gout are given under "Antigout Agents" and nonsteroid antiinflammatory agents under "NSAIDs".