antirheumatic

Antirheumatic drugs are medications used to treat rheumatic diseases, with the aim of reducing inflammation, relieving pain, and slowing or preventing joint damage. They are used in conditions such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and certain connective tissue diseases.

The term covers several classes. Conventional synthetic disease-modifying antirheumatic drugs (DMARDs) include methotrexate, hydroxychloroquine, sulfasalazine, and leflunomide, which modify the underlying immune process. Biological DMARDs are targeted therapies such as TNF inhibitors (infliximab, adalimumab, etanercept), IL-6 inhibitors, co-stimulation blockers, and B-cell–depleting agents. Targeted synthetic DMARDs include JAK inhibitors like tofacitinib, baricitinib, and upadacitinib. Non-DMARD antirheumatic medications, often used for symptoms, include nonsteroidal anti-inflammatory drugs and glucocorticoids.

Response and safety vary by drug. DMARDs may take several weeks to months to show full effect, and treatment is usually individualized, potentially involving combination therapy. Biologic and targeted agents require screening for infections and careful monitoring of immune-related side effects.

Ongoing monitoring includes laboratory tests for liver and kidney function, blood counts, and consideration of pregnancy, vaccination, and infection risk. Side effects range from infections and liver toxicity to cytopenias and gastrointestinal symptoms. The choice of therapy depends on disease type, activity, prior response, and patient factors.

In practice, antirheumatic therapy is coordinated by rheumatologists and may involve multidisciplinary care to optimize outcomes and manage comorbidities.