Different Drug Protocols for Rheumatoid Arthritis: An Exhaustive Review

Abstract

The chronic systemic autoimmune illness known as rheumatoid arthritis (RA) is typified by bone erosion, cartilage deterioration, and persistent synovitis. Its complicated immunopathogenesis includes environmental triggers, genetic susceptibility, and dysregulated cytokine networks.  Results have changed with the advent of treat to target tactics and a growing arsenal of disease-modifying antirheumatic medications (DMARDs). This review integrates information from significant research and guidelines to examine new and existing pharmacologic treatments for RA. Because of its effectiveness, affordability, and good long-term safety, methotrexate continues to be the cornerstone of conventional synthetic DMARD treatment. Leflunomide, hydroxychloroquine, and sulfasalazine are substitutes or combinations of these medications, especially in environments with low resources. T cell co-stimulation blockers and B cell depleting antibodies provide choices for refractory patients, whereas tumor necrosis factor inhibitors and interleukin 6 receptor antagonists lead the biologic DMARD class, which targets certain cytokines or cells. Targeted synthetic DMARDs, primarily Janus kinase (JAK) inhibitors like tofacitinib, baricitinib, and upadacitinib, offer quick onset and oral administration; nevertheless, because of the hazards of infection, thrombosis, and cardiovascular disease, they should be closely monitored. Analgesics, short-term corticosteroids, and non-steroidal anti-inflammatory medications are examples of bridge therapy that provide symptomatic relief but do not stop the course of the disease. Exercise, rehabilitation, nutrition, and patient education are examples of non-pharmacologic therapies that enhance quality of life and supplement medication. The review shows a flowchart for an evidence-based management strategy and provides tables that summarize pharmacological mechanisms, dosage, and side effects. The focus of future research will be on cell-based medicines, biosimilars, selective kinase inhibitors, and precision medicine. All things considered, the study emphasizes the need for customized treatment regimens that strike a balance between patient preferences, safety, and efficacy in order to achieve long-lasting remission and enhanced functional results.