These drugs are often referred to as first-line drugs. The anti-inflammatory and analgesic effects are mainly achieved by inhibiting the synthesis of prostaglandin. In addition, these drugs can inhibit phosphodiesterase, increase intracellular cAMP, increase lysosomal membrane stability and reduce enzyme release. However, although these drugs can alleviate the symptoms, they have no fundamental influence on the immune response that causes rheumatoid arthritis, so they can't control the development of the disease and can only improve the symptoms.
① Indomethacin. The initial dose was 75mg per day, which was taken orally three times after meals, and then gradually increased to 100 ~ 150 mg per day. Pregnant women, peptic ulcer and mental patients are prohibited.
② Aspirin. Take 3 mg ~ 4 g orally every day for 4 ~ 6 hours, 65438 0 times.
③ Piroxicam. Take 20mg orally each time, daily 1 time, after meals.
④ ibuprofen. 1 ~ 18g daily, taken orally 3-4 times. Less side effects.
⑤ Naproxen. Take 250mg orally twice a day. Less side effects.
⑥ Flufenamic acid. 0.2 ~ 0.4 mg orally each time. Three times a day.
First-line drugs do not advocate combined use. If one drug is still ineffective after 3 weeks of application, another drug can be replaced. Second-line drugs should be considered when the treatment is ineffective for half a year.
(2) Relieving drugs
These drugs are also called second-line drugs. Its characteristic is slow action, which can affect the pathological process of disease immune response.
(1) gold salt. Can improve humoral immunity and cellular immunity, reduce bone erosion and destruction, and inhibit synovitis. 25mg gold salt preparation is effective by intravenous injection every week. Include gold sodium thiomalate and auranofin. Oral auranofin 6mg, 65438+ 0 times a day. 15 years, 37% of rheumatoid factors turned negative.
② Penicillamine. It can break the disulfide bond of macroglobulin, depolymerize and reduce RF level. The dosage was 250 ~ 1800 mg per day, and it was changed to 250mg per day after the condition improved.
It takes effect 1.5 ~ 2 months after taking the medicine. Side effects include rash, liver injury and bone marrow suppression.
③ Chloroquine and its derivatives. The initial dose of chloroquine is 250 ~ 500mg per day, with an average of 6mg/kg per day. Use with caution in patients with cardiomyopathy, keratopathy and retinopathy. In order to reduce side effects, it only takes 10 months every year.
④ Levamisole. It acts like penicillamine. It can moderately improve the symptoms of rheumatoid arthritis, enhance the functions of lymphocytes and natural killer cells, and has better curative effect when combined with first-line drugs.
Usage: 25 ~ 50mg, taken orally, three times a day, once a week, stopping taking medicine for two days, 12 weeks is a course of treatment.
(3) Adrenal glucocorticoid
Such drugs are generally not preferred. Its application indications are as follows.
① When routine treatment fails, first-line and second-line drugs can be combined.
② Serious extra-articular complications, such as pericarditis, pleurisy, vasculitis, iridocyclitis, etc.
Principle of use: minimum dose (e.g. prednisone is less than 10mg per day). Minimal stage (aseptic osteonecrosis is easy to occur after long-term use). Reduce or even stop using it as soon as possible.
(4) Immunosuppressants
These drugs are also called third-line drugs. First-and second-line drugs are ineffective or have serious reactions.
① Cyclosporine. It can inhibit lymphocyte activation induced by T helper cells or delay the production of cytokines related to allergic reaction. The dosage is daily 10mg/kg, intravenous injection.
After 60 days of treatment, the total effective rate was 54%.
② sulfasalazine. It can inhibit the immunopathological process and prevent and treat related infection causes. It can be taken orally, 2g a day, 3g a day when symptoms are severe, and two months is a course of treatment. It can obviously improve morning stiffness, grip strength, erythrocyte sedimentation rate and C-reactive protein.
③ Cyclophosphamide. It is effective for refractory rheumatoid disease. But it has many side effects and is not the first choice.
Every time 100 ~ 200mg, intravenous drip or intravenous injection, twice a week1~, with a total course of treatment of 3g. The side effects were myelosuppression and hemorrhagic cystitis.
④ Azathioprine. The maximum dose is 2.5 ~ 3 mg/kg per day. If allopurinol is used at the same time, the dosage of the drug will be reduced by 25%.
⑤ Methotrexate. It can block the transformation of dihydrofolate into tetrahydrofolate, thus inhibiting rheumatoid arthritis and achieving immunosuppression and anti-inflammatory effects. The weekly dosage is 25 ~ 50 mg. 12 hours orally 1 time, three times in a row. The course of treatment does not exceed 6 months. It has a significant effect on those who are ineffective in first-and second-line drugs. Pregnant women are forbidden to avoid fetal malformation.
(5) molecular immunity
① Interferon-γ. Interferon-γ produced by recombinant deoxyribonucleic acid technology can inhibit the replication of DNA and ribonucleic acid, inhibit the proliferation of T cells and reduce humoral and cellular immune responses. 6,543,800,000 units each time, intramuscular injection. Seven times is 1 course of treatment.
② Specific antibody. It is an antibody produced by monoclonal antibodies of lymphocytes sensitized by human tumor cells. It has the characteristics of high purity and strong specificity. It (immunotoxin) is immunoconjugated with mouse monoclonal antibody and ricin A chain, specifically binds to T cell subsets, and repeatedly inactivates RNA through enzyme-like action, destroying and killing these cells. The dose of IT treatment is 0.05 ~ 0.33 mg/kg per day, and the course of treatment is 5 ~ 65,438+00 days.
Results The effective rate was 50%.
(6) Other drugs
(1) Captopril. The structure of this product is similar to penicillamine, which can block the release of bradykinin and reduce the production of prostaglandin. Usage: 12.5 ~ 25mg, taken orally, three times a day. 200 milligrams a day at most. Generally, the symptoms improved obviously in 2 ~ 3 months, and the negative rate of rheumatoid factor was 67%.
② Zinc preparation: zinc sulfate 10mg/kg/ day. Adults should not exceed 700mg per day, and children should not exceed 150mg per day. It is generally believed that the improvement of immune indicators is better than the improvement of symptoms.