Disease Modifying Antirheumatic Drugs (DMARD’s

• Blood disorders including haemolytic anaemia and leukopenia

I N TE R A C TI O N S • 6-Mercaptopurine (increased risk of toxicity)

C L I N I C A L N O TE • A prophylactic NSAID (which is not aspirin) or colchicine is usually co-administered • Check if patient who presents with gout is prescribed a thiazide diuretic before prescribing

U R I C O S U R I C A G E NT S : P R O B E NE C I D

M E C H A N I S M O F A C T I O N

• Increase uric acid secretion by inhibiting reabsorption in the proximal tubule • Mechanism of action is unclear but it lowers plasma urate, dissolves urate crystals and reverses crystal deposition in synovial joints

I N D I C A TI O N S

• Tumour lysis syndrome (chemotherapy) to prevent kidney damage

DI S E A S E MO D I F Y I NG AN T I R H E U M A T I C DR U G S (D M A R D ’ S)

H Y D R O X Y C H L O R O Q U I N E & S U L P H A S A L A Z I NE

M E C H A N I S M O F A C T I O N • MOA unclear but has a long term depressive effect on inflammation by improving symptoms and reducing disease activity. • Hydroxychloroquine interferes with leukocyte function inhibiting IL-1. • Also has inhibitory effect on the DNA synthesis at high doses. • Sulphasalazine is the most commonly used DMARD in the U.K.

I N D I C A TI O N S • Suppressive treatment and treatment of acute attacks of malaria. • Treatment of discoid and systemic lupus erythematosus, and rheumatoid arthritis.

C L I N I C A L N O TE • Hydroxychloroquine is reserved for cases where other treatments have failed. • Low toxicity. • Acute haemolysis may be caused in those with G6PDH deficiency.

G O L D A ND P E NI C I L L A M I NE