Which medication is a disease-modifying antirheumatic drug commonly used to treat rheumatoid arthritis?

Which medication is a disease-modifying antirheumatic drug commonly used to treat rheumatoid arthritis?

• A. Prednisone
• B. Allopurinol
• C. Methotrexate
• D. Colchicine

Answer: (C)

Disease-modifying antirheumatic drugs slow the progression of rheumatoid arthritis by altering the underlying immune process rather than just providing symptom relief. Methotrexate fits this role best because, at low weekly doses, it suppresses autoimmune inflammation and reduces long-term joint damage, helping to preserve function over time. Its mechanism includes inhibition of dihydrofolate reductase, which decreases immune cell proliferation, and an increase in extracellular adenosine that has anti-inflammatory effects. Because it can cause liver toxicity, bone marrow suppression, and other issues, it’s important to monitor liver enzymes, blood counts, and renal function, and to use folic acid supplementation to lessen side effects. It's commonly started early and used long-term as the foundational therapy, sometimes with additional DMARDs or biologics if needed. Prednisone is a corticosteroid that provides rapid symptom relief but does not change the disease course, so it’s often used for short-term control or bridging. Allopurinol targets uric acid production for gout, not rheumatoid arthritis. Colchicine is an anti-inflammatory used primarily for gout, not a disease-modifying agent in RA.

Disease-modifying antirheumatic drugs slow the progression of rheumatoid arthritis by altering the underlying immune process rather than just providing symptom relief. Methotrexate fits this role best because, at low weekly doses, it suppresses autoimmune inflammation and reduces long-term joint damage, helping to preserve function over time. Its mechanism includes inhibition of dihydrofolate reductase, which decreases immune cell proliferation, and an increase in extracellular adenosine that has anti-inflammatory effects. Because it can cause liver toxicity, bone marrow suppression, and other issues, it’s important to monitor liver enzymes, blood counts, and renal function, and to use folic acid supplementation to lessen side effects. It's commonly started early and used long-term as the foundational therapy, sometimes with additional DMARDs or biologics if needed.

Prednisone is a corticosteroid that provides rapid symptom relief but does not change the disease course, so it’s often used for short-term control or bridging. Allopurinol targets uric acid production for gout, not rheumatoid arthritis. Colchicine is an anti-inflammatory used primarily for gout, not a disease-modifying agent in RA.