title: Pharmacokinetic consideration of synthetic DMARDs in rheumatoid arthritis.
abstract: BACKGROUND
  Current treatment strategy for rheumatoid arthritis (RA) focuses on tight disease control and remission. The present understanding of the immune-pathological process of RA, mechanism of synthetic DMARDs and the clinical experience of the drugs have raised certain concerns over their clinical use.
  
  
  METHODS
  The review summarizes latest concepts in the pathogenesis of RA, and the mechanism of action and pharmacokinetics of commonly used synthetic DMARDs. It also covers the principle of enzyme and receptor kinetics, and limitation of current knowledge on RA disease measures.
  
  
  CONCLUSIONS
  There is a need to rationalize the use of synthetic DMARDs to help improve RA treatment. One recommendation to assist the rationalization of this treatment is by the construction of suitable models of the disease process, thereby augmenting treatment options. Currently, the dosage and duration of this type of treatment is based on its overall effect and clinical outcome. Each DMARD will confer its effect on a specific component of the multilevel, multicellular, pathological process of RA. Furthermore, developing definitive biomarkers could help to better assess the disease at its various stages instead of using conventional RA measures for drug titration and to help in the rationalization of drug regimen. Integrating pharmacokinetic and pharmacodynamic properties into this model will also help in improving treatment outcomes.
authors.affiliation: ChanRe Rheumatology and Immunology Center, Department of Immunology and Rheumatology, Bangalore 560079, India. chandrashekara_s@yahoo.com
authors.forename: S
authors.initials: S
authors.lastname: Chandrashekara
mesh_terms: D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000138:chemical synthesis* / Q000493:pharmacokinetics*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D015415:Biomarkers / Q000097:blood; D006801:Humans; D008954:Models, Biological; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D015415:Biomarkers