Option 12: Other Immunomodulatory and Cytotoxic agents
Other immunomodulatory and cytotoxic agents, such as azathioprine, cyclosporine, and cyclophosphamide, may be considered in some cases for the treatment of RA. These medications work by suppressing the immune system’s overactivity, which can help reduce inflammation and joint damage. They are typically reserved for patients who have not responded adequately to other DMARDs or biologic medications or in situations where other treatment options are contraindicated.
Azathioprine is an immunosuppressive drug that works by interfering with the synthesis of DNA, RNA, and proteins, which are essential for immune cell function. This medication can be taken orally and is sometimes used to treat RA patients who have not responded well to other DMARDs. However, its use requires careful monitoring due to potential side effects, including liver and bone marrow toxicity.
Cyclosporine, another immunosuppressive medication, works by inhibiting the activity of immune cells called T-lymphocytes. This drug is taken orally and can be effective in treating RA, particularly in combination with other DMARDs. Nonetheless, cyclosporine use comes with a risk of kidney toxicity and requires close monitoring of blood pressure and kidney function.
Cyclophosphamide, a potent cytotoxic agent, is occasionally used in severe, refractory cases of RA. It is typically administered intravenously and works by suppressing the immune system and reducing inflammation. Due to its potential for severe side effects, including bone marrow suppression and an increased risk of malignancy, cyclophosphamide is generally reserved for patients with life-threatening complications or those who have not responded to other treatments.
The use of these medications requires close monitoring by a healthcare provider due to potential side effects, including an increased risk of infections and organ toxicity. Regular blood tests and follow-up appointments are necessary to ensure the safe and effective use of these immunomodulatory and cytotoxic agents. (12)
