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an impairment of health or a condition of abnormal functioning
use recreational drugs (同)do drugs
administer a drug to; "They drugged the kidnapped tourist" (同)dose
a substance that is used as a medicine or narcotic
caused by or altered by or manifesting disease or pathology; "diseased tonsils"; "a morbid growth"; "pathologic tissue"; "pathological bodily processes" (同)morbid, pathologic, pathological

PrepTutorEJDIC

(体の)『病気』,疾患 / (精神・道徳などの)病気,病弊
女性の話術芸人 =diseur
『薬』,薬品,薬剤 / 『麻薬』,麻酔剤 / 〈人〉‘に'薬(特に麻酔剤)を与える / 〈飲食物〉‘に'(麻酔薬・毒薬などの)薬を混ぜる
病気にかかった / 病的な,不健全な(morbid)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/03/12 02:22:52」(JST)

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Methotrexate

Hydroxychloroquine

Auranofin, a gold salt

Disease-modifying antirheumatic drugs (DMARDs) is a category of otherwise unrelated drugs defined by their use in rheumatoid arthritis to slow down disease progression.^[1]^[2] The term is often used in contrast to non-steroidal anti-inflammatory drug (which refers to agents that treat the inflammation but not the underlying cause) and steroids (which blunt the immune response but are insufficient to slow down the progression of the disease).

The term "antirheumatic" can be used in similar contexts, but without making a claim about an effect on the course.^[3] Other terms that have historically been used to refer to the same group of drugs are "remission-inducing drugs" (RIDs) and "slow-acting anti-rheumatic drugs" (SAARDs).^[4]

Terminology

Although the use of the term DMARD was first propagated in rheumatoid arthritis (hence their name) the term has come to pertain to many other diseases, such as Crohn's disease, lupus erythematosus (SLE), Sjogren's Syndrome, immune thrombocytopenic purpura (ITP), myasthenia gravis, sarcoidosis and various others.

The term was originally introduced to indicate a drug that reduced evidence of processes thought to underlie the disease, such as a raised erythrocyte sedimentation rate, reduced haemoglobin level, raised rheumatoid factor level and more recently, a raised C-reactive protein level.^{[citation needed]} More recently, the term has been used to indicate a drug that reduces the rate of damage to bone and cartilage.^{[citation needed]} DMARDs can be further subdivided into traditional small molecular mass drugs synthesised chemically and newer 'biological' agents produced through genetic engineering.

Some DMARDs (e.g. the Purine synthesis inhibitors) are mild chemotherapeutics but use a side-effect of chemotherapy - immunosuppression - as its main therapeutical benefit.

Subdivision

DMARDs have been classified as:^[5]

synthetic (sDMARD)

* conventional synthetic and targeted synthetic DMARDs (csDMARDs and tsDMARDs, respectively)

* csDMARDs are the traditional drugs (such as methotrexate, sulfasalazine, leflunomide, hydroxychloroquine, gold salts)

* tsDMARDs are drugs that were developed to target a particular molecular structure

biological: original and biosimilar DMARDs (boDMARDs and bsDMARDs)

* bsDMARDs are those that have the same primary, secondary and tertiary structure as an original (boDMARD) and possess similar efficacy and safety as the original protein

Members

Drug	Mechanism
abatacept	T-cell costimulatory signal inhibitor
adalimumab	TNF inhibitor
azathioprine	Purine synthesis inhibitor
chloroquine and hydroxychloroquine (antimalarials)	Suppression of IL-1 & TNF-alpha, induce apoptosis of inflammatory cells and decrease chemotaxis
ciclosporin (Cyclosporin A)	calcineurin inhibitor
D-penicillamine (seldom used today)	Reducing numbers of T-lymphocytes etc.
etanercept	decoy TNF receptor
golimumab	TNF inhibitor
gold salts (sodium aurothiomalate, auranofin) (seldom used today)	unknown
infliximab	TNF inhibitor
leflunomide	Pyrimidine synthesis inhibitor
methotrexate (MTX)	Purine metabolism inhibitor
minocycline	5-LO inhibitor
rituximab	chimeric monoclonal antibody against CD20 on B-cell surface
sulfasalazine (SSZ)	Suppression of IL-1 & TNF-alpha, induce apoptosis of inflammatory cells and increase chemotactic factors

Although these agents operate by different mechanisms, many of them can have similar impact upon the course of a condition.^[6]

Some of the drugs can be used in combination.^[7] A common triple therapy for rheumatoid arthritis is methotrexate, sulfasalazine, and hydroxychloroquine.

Alternatives

When treatment with DMARDs fails, cyclophosphamide or steroid pulse therapy is often used to stabilise uncontrolled autoimmune disease. Some severe autoimmune diseases are being treated with bone marrow transplants in clinical trials, usually after cyclophosphamide therapy has failed. Furthermore, should DMARDs fail, tocilizumab can be used for tumor necrosis factor (TNF) inhibitor treatments in NICE guidance.^[8]

Combinations of DMARDs are often used together, because each drug in the combination can be used in smaller dosages than if it were given alone, thus reducing the risk of side effects.

Many patients receive an NSAID and at least one DMARD, sometimes with low-dose oral glucocorticoids. If disease remission is observed, regular NSAIDs or glucocorticoid treatment may no longer be needed. DMARDs help control arthritis but do not cure the disease. For that reason, if remission or optimal control is achieved with a DMARD, it is often continued at a maintenance dosage. Discontinuing a DMARD may reactivate disease or cause a “rebound flare”, with no assurance that disease control will be reestablished upon resumption of the medication.

References

‹ The template below (Research help) is being considered for deletion. See templates for discussion to help reach a consensus.›

^ "disease-modifying antirheumatic drug" at Dorland's Medical Dictionary
^ "Disease modifying antirheumatic drugs (DMARDs)".
^ "antirheumatic" at Dorland's Medical Dictionary
^ Buer, Jonas Kure. 2015. "A history of the term “DMARD”." Inflammopharmacology 23 (4):163-171. doi: 10.1007/s10787-015-0232-5.
^ Smolen JS, van der Heijde D, Machold KP, Aletaha D, Landewé R. Proposal for a new nomenclature of disease-modifying antirheumatic drugs. Ann Rheum Dis. 2014 Jan;73(1):3-5. doi: 10.1136/annrheumdis-2013-204317.
^ Nandi P, Kingsley GH, Scott DL (May 2008). "Disease-modifying antirheumatic drugs other than methotrexate in rheumatoid arthritis and seronegative arthritis". Current Opinion in Rheumatology 20 (3): 251–6. doi:10.1097/BOR.0b013e3282fb7caa. PMID 18388514.
^ Capell HA, Madhok R, Porter DR, et al. (February 2007). "Combination therapy with sulfasalazine and methotrexate is more effective than either drug alone in patients with rheumatoid arthritis with a suboptimal response to sulfasalazine: results from the double‐blind placebo‐controlled MASCOT study". Annals of the rheumatic diseases 66 (2): 235–41. doi:10.1136/ard.2006.057133. PMC 1798490. PMID 16926184.
^ http://www.mims.co.uk/news/1124108/Tocilizumab-Treatment-Rheumatoid-Arthritis-TA247

UpToDate Contents

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1. リウマチ性疾患における免疫抑制剤および疾患修飾剤の使用の概要 overview of the use of immunosuppressive and disease modifying drugs in the rheumatic diseases
2. 成人における初回の抗リウマチ薬（DMARD）治療に抵抗性の活動性関節リウマチに対する治療 treatment of rheumatoid arthritis resistant to initial dmard therapy in adults
3. 成人における関節リウマチのマネージメントの一般的原則 general principles of management of rheumatoid arthritis in adults
4. 成人における中等度～重度の活動性関節リウマチの初期治療 initial treatment of moderately to severely active rheumatoid arthritis in adults
5. 患者情報：疾患修飾抗リウマチ薬（DMARDs）（詳細） disease modifying antirheumatic drugs dmards beyond the basics

English Journal

Current smoking status is a strong predictor of radiographic progression in early rheumatoid arthritis: results from the SWEFOT trial.

Saevarsdottir S1, Rezaei H1, Geborek P2, Petersson I3, Ernestam S4, Albertsson K5, Forslind K6, van Vollenhoven RF7; SWEFOT study group.
Annals of the rheumatic diseases.Ann Rheum Dis.2015 Aug;74(8):1509-14. doi: 10.1136/annrheumdis-2013-204601. Epub 2014 Apr 4.
OBJECTIVES: To study clinical predictors for radiographic progression after 1 year in an early rheumatoid arthritis (RA) trial.METHODS: In the SWEFOT trial population, disease modifying antirheumatic drug (DMARD) naïve RA patients started methotrexate; 3-month responders (DAS28 <3.2) continued
PMID 24706006

Evaluating Indeterminate Interferon-γ-Release Assay Results in Patients With Chronic Inflammatory Diseases Receiving Immunosuppressive Therapy.

Calabrese C1, Overman RA2, Dusetzina SB3, Hajj-Ali RA1.
Arthritis care & research.Arthritis Care Res (Hoboken).2015 Aug;67(8):1063-9. doi: 10.1002/acr.22454.
OBJECTIVE: To analyze the rate of indeterminate interferon-γ-release assay (specifically the QuantiFeron-TB Gold In-Tube [QFT-GIT]) testing for Mycobacterium tuberculosis in patients with chronic inflammatory disease (CID) compared with the general hospital population (GH) and a healthy reference g
PMID 25186123

Analysis of patents on anti-rheumatoid arthritis therapies issued in China.

Yuan HY1, Zhang XL, Zhang XH, Meng L, Wei JF.
Expert opinion on therapeutic patents.Expert Opin Ther Pat.2015 Aug;25(8):909-30. doi: 10.1517/13543776.2015.1044972. Epub 2015 Jun 12.
INTRODUCTION: The etiology of rheumatoid arthritis (RA) is complex and diverse. Chronic inflammatory processes with joint dysfunction can cause permanent disability. Therefore, the development of new drugs and therapies for RA is very important.AREAS COVERED: This review analyzes the existing patent
PMID 26066366

Japanese Journal

病気について知りたい! 臨床講座(82)関節リウマチ : Up-To-Date

Pharma tribune : なりたい薬剤師になる! 7(10), 5-16, 2015-10
NAID 40020624184

メトトレキサートとタクロリムス内服中にニューモシスチス肺炎を合併した関節リウマチの一例

臨床リウマチ 27(1), 64-70, 2015
NAID 130005067622

大阪府下整形外科開業医における関節リウマチ診療の変化大阪臨床整形外科医会会員アンケート結果 2003年・2008年・2013年の比較から

臨床リウマチ 27(1), 28-36, 2015
NAID 130005067618

Related Pictures

★リンクテーブル★

リンク元	「抗リウマチ薬」「antirheumatic agent」
関連記事	「disease」「drug」

「抗リウマチ薬」

　　[★]

英: antirheumatic drug
同: 疾患修飾性抗リウマチ薬 disease-modifying antirheumatic drug DMARD、遅効性抗リウマチ薬 slow-acting antirheumatic drug SAARD
関

定義

1. 関節リウマチの治療薬であって、関節破壊を抑制する薬剤のことを指す(出典不明)

遅効性：一般的にこれらの薬剤は効果が出るまでに数ヶ月要する(別名：SAARDs, slow-acting antirheumatic drugs, 遅効性抗リウマチ薬)。

2. 関節リウマチの治療薬のこと。金剤、D-ペニシラミンなど。DMARDsとも呼ばれる(REU.66)

免疫抑制薬は、抗リウマチ薬が奏功しない、あるいは疾患の活動性が高いときに切り札的に用いられるが、これを抗リウマチ薬にふくめるかどうかは謎。(REU.66では抗リウマチ薬に含めていない)

3. http://en.wikipedia.org/wiki/Disease-modifying_antirheumatic_drug

Disease-modifying antirheumatic drugs (DMARDs) is a category of otherwise unrelated drugs defined by their use in rheumatoid arthritis to slow down disease progression. The term is often used in contrast to non-steroidal anti-inflammatory drug, which refers to agents that treat the inflammation but not the underlying cause.
The term "antirheumatic" can be used in similar contexts, but without making a claim about an effect on the course.

抗リウマチ薬はRAの進行を抑えるかどうかは問わない。抗リウマチ薬の下位概念としてDMARDがある(NSAIDsも含まれると考えて良いだろう)。DMARDはNSAIDsを待避させた概念か。