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Methotrexate (green) complexed into the active site of DHFR (blue) Methotrexate is an antimetabolite of the antifolate type. It is thought to affect cancer and rheumatoid arthritis by two different pathways. For cancer, methotrexate competitively inhibits dihydrofolate reductase (DHFR), an enzyme that participates in the tetrahydrofolate synthesis.
The typical first-line pharmacological recommendation for patients with symptomatic rheumatoid arthritis is DMARD monotherapy (Methotrexate preferred). In moderate or severe disease activity, it is recommended to combine conventional DMARDs, add a TNF-α Inhibitors or a non-TNF biologic or Tofacitinib. [3]
Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints. [1] It typically results in warm, swollen, and painful joints. [1] Pain and stiffness often worsen following rest. [1] Most commonly, the wrist and hands are involved, with the same joints typically involved on both sides of the body. [1]
Methotrexate Hydroxychloroquine Auranofin, a gold salt. Disease-modifying antirheumatic drugs (DMARDs) comprise a category of otherwise unrelated disease-modifying drugs defined by their use in rheumatoid arthritis to slow down disease progression.
Large, double-blind randomized controlled trials in patients with rheumatoid arthritis have shown that golimumab in combination with methotrexate was more effective than methotrexate alone. [20] When clinically indicated, golimumab is estimated as a moderate cost-effective treatment option.
5.1 Mechanism of action. 5.2 Pharmacokinetics. 6 ... In ex vivo models of arthritis, ... the cost to the Australian government for a year of treatment is about $8500 ...
Methotrexate is a folic acid analogue. It binds dihydrofolate reductase and prevents synthesis of tetrahydrofolate. It is used in the treatment of autoimmune diseases (for example rheumatoid arthritis or Behcet's Disease) and in transplantations.
Anakinra, sold under the brand name Kineret, is a biopharmaceutical medication used to treat rheumatoid arthritis, cryopyrin-associated periodic syndromes, familial Mediterranean fever, and Still's disease. [3] It is a slightly modified recombinant version of the human interleukin 1 receptor antagonist protein. [3]