10.1.3 Drugs that suppress the rheumatic disease process

General Guidance
 

• Disease-modifying antirheumatic drugs (DMARDs) should be considered for all patients with rheumatoid arthritis.
• Early use of DMARDs delays progression of the condition, retains function and slows disability and its commencement should be considered after three months if rheumatoid arthritis has been confirmed.
• Ideally DMARD therapy should be commenced on specialist advice. However, if there is likely to be a delay in the patient been seen by a specialist and a general practitioner is certain of the diagnosis of rheumatoid arthritis initiation of sulphasalazine therapy by the GP prior to specialist advice is recommended especially if symptoms are significant and appear to be getting worse.
• DMARD therapy may require 4-6 months for a full response. Therapy improves the symptoms and signs of inflammatory joint disease and extra-articular symptoms such as vasculitis.
• DMARD therapy requires monitoring in order to reduce potential toxicity.

Recommended drugs

Sulfasalazine enteric coated

Suitable for specialist initiation only

Methotrexate ONCE WEEKLY DOSING ONLY

Zlatal solution for injection in pre-filled syringe (Methotrexate) ONCE WEEKLY DOSING ONLY

Hydroxychloroquine

Leflunomide

Ciclosporin

Gold - Sodium aurothiomalate

Combination therapy

Drug Traffic Light Key:

Green – On Formulary

Amber – Restricted use, see local guidelines      

Purple – Specialist use/initiation

Red – Non Formulary

Relative Costs Key (where indicated):

£££££ - high

£££ - moderate

£ - low