1.Non-steroidal anti-inflammatory drugs
Diclofenac sodium (Fotarim) 75mg/tablet, 75mg, po, qd~bid
Meloxicam (Mupirocor) 7.5mg/tablet, 7.5mg~15mg, po, qd~bid
Celecoxib (Celebrex) 100mg/capsule, 100mg~200mg, po, qd~bid
Loxoprofen (Loxone) 60mg/tablet, 60mg, po, qd~bid
2.Slow-acting antirheumatic drugs
2.1 Methotrexate (MTX) 2.5mg/tablet
Dosage: 5~15mg, orally, once a week, the maximum dose does not exceed 20mg/w, with 3~12w onset of action.
Pharmacological effects: This drug is an inhibitor of dihydrofolate reductase, which can inhibit cell proliferation and replication, repair bone destruction, and is one of the drugs of choice for the treatment of RA. MTX has inhibited leukocyte chemotaxis and thus has direct anti-inflammatory effects. Small doses of folic acid or folinic acid can be used together with MTX to reduce the toxic side effects of MTX without affecting the efficacy.
2.2 Salazosulfapyridine (Velupyridine) (SSZ/SASP) 0.25g/tablet, 0.25g, po, qd
2.3 Leflunomide (Eroflav, Toloxil) (LEF) 10mg/tablet, 10mg~20mg, po, qd
2.4 Hydroxychloroquine(HCQ) 0.1g/tablet, 0.1g~0.2g, po, bid
2.5 Thalidomide (Reaction Stop) 25mg/tablet
Usage: autoimmune disease: 75mg~100mg, po, qn, starting from small dose; for its side effect of drowsiness, can be used to improve patients’ excitement insomnia due to hormone use.
2.6 Azathioprine (Imuran) (AZA) 50mg/tablet
Usage: Starting dose 2~2.5mg/(kg. d), reduce to 50mg after onset of action, qd maintenance.
2.7 Cyclophosphamide (CTX) 50mg/tablet
Usage: Generally 50mg~100mg, po, qd; injection is used according to the specific situation, intravenous shock therapy 0.75~1.0g/m2 body surface area.
2.8 Cyclosporine A (New Sesquiterpene) (CSA) 25mg/capsule
Dosage: The dose depends on the patient’s condition, generally it can be 2.5~5mg/(kg.d)
2.9Mortimerol (primidone, cyclobenzaprine) (MMF) 0.25g/tablet
Indications: Mainly used for the treatment of lupus nephritis.
Usage: Induction period: 1.5~2.0g/d, the tolerated amount is lower in the East than in the West, generally choose a small dose and use for at least 3 months; maintenance period: 0.5g/d, use for 3 years. Pay attention to the monitoring of blood concentration, too low will not achieve the efficacy, too high will easily induce adverse reactions.
3.Biological agents
3.1 Recombinant human type II tumor necrosis factor receptor-antibody fusion protein (Iscap) 12.5mg/pc
Indications: This product is indicated for patients with moderate or severe RA, childhood idiopathic arthritis, ankylosing spondylitis, psoriatic arthritis and inflammatory bowel disease in whom 2 or more slow-acting antirheumatic drugs are ineffective.
Dosage: Recommended dose 25mg, ih, twice a week. Dissolve with 1ml of water for injection before injection, and can be refrigerated for 72h after dissolution
3.2 Infliximab (class gram) 100mg/pc
Dosage: administered intravenously, starting dose 3mg/kg, recommended to be administered in the 1st, 2nd and 6thw, and every 8w thereafter. The efficacy can be increased to 10mg/kg or once every 4w.
4.Phyto-extracted drugs
4.1 Radix Polygoniacin Tablets 10mg/tablet, 20mg, po, tid, average 7d onset of action.
4.2 White peony total glucoside tablet (pafolin) 0.3g/tablet, 0.6g, po, bid~tid.
4.3 Zhengqing Fengxin (Qingtanine) 0.6g/tablet, 1~4 tablets, bid~tid.
5.Glucocorticoids
5.1 Prednisone 5mg/tablet
5.2 Methylprednisolone (Medrol) 4mg/tablet
Classification of glucocorticoids: long-acting: such as dexamethasone, betamethasone, half-life 36~54h, which can affect the secretion curve of the body; medium-acting: methylprednisolone (methylprednisolone), prednisone acetate (prednisone), half-life 12~36h, most widely used in clinical practice, pay attention to the administration time and interval; short-acting: hydrocortisone, cortisone, half-life 8~12h, mostly used in emergency situations.
Comparison of commonly used glucocorticoid preparations (equivalent doses)
Hydrocortisone 20mg = cortisone 25mg = prednisone 5mg = prednisolone 5mg = methylprednisolone 4mg = deferiprone 4mg = dexamethasone 0.75mg = betamethasone 0.75mg
Main side effects of glucocorticoids
Mainly secondary infection, centripetal obesity, diabetes, hypertension, atherosclerosis, upper gastrointestinal bleeding, ischemic osteonecrosis, osteoporosis, etc.
6.Intra-articular injection drugs
6.1 Compound betamethasone (Depo-Provera) 1ml/pc
Usage: Recommended dose of intra-articular injection: large joints (knee, hip, shoulder) 1~2ml/time; medium joints (elbow, wrist, ankle): 0.5~1ml/time; small joints (foot, hand, chest) 0.25~0.5ml/time.
Note: The number of injections in each joint cavity is less than 3 times per year and is prohibited for intravenous use.
6.2 Sodium vitreous acid (Spironolactone) 2ml: 20mg/pc
Usage: Intra-articular injection, 2ml each time, once a week, 5w as a course of treatment.
7.Anti-gout drugs
7.1 Colchicine 0.5mg/tablet
Usage: During acute attack of gout: 0.5mg every hour or 1mg every 2 hours until one of the 3 discontinuation indicators occurs: relief of joint symptoms; total amount up to 6mg not relieved; aggravated gastrointestinal reactions or other adverse reactions such as WBC reduction, remittance, liver damage, alopecia, myopathy, etc. Blood picture must be observed for long-term use.
7.2 Allopurinol 100mg/tablet (inhibits uric acid synthesis)
Dosage: 100mg, po, tid, max dose 600mg/d
7.3 Benzbromarone 50mg/tablet (to promote uric acid excretion)
Dosage: start with small dose, 25mg, qd (after breakfast), can be gradually increased to 100mg, qd
7.4 Sodium bicarbonate (baking soda) 0.5g/tablet 1~2g, po, tid
8.Anti-osteoporosis drugs
8.1 Calcium carbonate D3 tablets (Calcium D) 0.6g/tablet 0.6g, bid~tid
8.2 Alfacalcidol (Alfa D3) 0.25ug/capsule 0.25ug~0.5ug, po, qd
8.3 Alendronate (Fosamax) 70mg/tablet 70mg, po, qw
8.4 Salmon calcitonin (mikacalcitol) 50iu/pc 50iu, im, qd
9.Other drugs
Technetium 99TC methylene diphosphonate injection (Yunque): 99TC-MDP
Pharmacological effect: This product is a chelate of artificial trace element technetium (99TC) and methylene diphosphonate (MDP), which can obviously inhibit the production of interleukin 1 by macrophages and has anti-inflammatory effect. It has obvious analgesic effect. This product has obvious targeting to the bone and joint parts.
Indications: RA, ankylosing spondylitis, psoriasis and psoriatic arthritis, can inhibit cancer bone metastasis, has analgesic effect on cancer bone metastasis, can prevent and treat osteoporosis, prevent fracture, frozen shoulder, gout, rheumatoid arthritis and other bone and joint diseases.
Contraindications: Contraindicated in patients with allergies, low blood pressure, severe liver and kidney dysfunction.
Adverse reactions: Rash, local redness and swelling of injection, loss of appetite, weakness, increased menstruation, rare generalized edema; in severe cases, discontinuation of treatment is required.
Dosage: Add 15mg to 250ml of liquid and drip once a day for 15 days.