Conventional DMARDs

Methotrexate

Cornerstone of Rheumatoid Arthritis treatment

Anti-metabolite, increases adenosine levels

Well tolerated, but need to monitor liver enzymes

Contraindicated w/ renal insufficiency and pregnancy

Hydroxychloroquine

Treats Lupus / Rheumatoid Arthritis

Alters lysosomal pH / TLR signaling

Relatively safe, but need to monitor for retinal toxicity

Sulfasalazine

Treats Rheumatoid Arthritis

Sulfa allergy is common

Unknown MOA

Azathioprine

Treats Lupus, Vasculitis, some Rheumatoid Arthritis

Inhibits de novo Purine synthesis, decreasing B and T cell proliferation

Bone marrow suppression, can be used in pregnancy

Minocycline

Acts on metal metalloproteases

Treats Rheumatoid Arthritis / Acne

Safe but low potency in RA

Rare drug-induced Lupus

Leflunomide

Treats Rheumatoid Arthritis

Inhibits Dihydroorotate Dehydrogenase —> prevents pyrimidine synthesis —> decreases B and T cell proliferation

Used as Methotrexate alternative

Contraindicated in pregnancy