Table 1

Summary of drugs commonly used in rheumatic diseases and their mechanisms of action

DrugsMechanisms of action
GlucocorticoidsInhibit NF-κB; suppress immune cell function; decrease cytokine production; increase apoptosis of immune cells.24
HydroxychloroquineInterfere with lysosomal activity, autophagy and membrane stability; alter signalling and transcriptional activity; inhibit cytokine production; modulate costimulatory molecules.25
MethotrexatePyrimidine and purine metabolism inhibitor via inhibition of dihydrofolate reductase; stimulation of adenosine signalling; downregulation of cytokines, eicosanoids and matrix metalloproteinases.26
LeflunomidePyrimidine synthesis inhibitor via inhibition of dihydroorotate dehydrogenase.
AzathioprinePurine synthesis inhibitor; inhibits lymphocyte proliferation.27
CyclosporineCalcineurin inhibitor; binds cyclophilin; blocks T cell activation and inhibits cytokine transcription.28
TacrolimusCalcineurin inhibitor; binds FK506 binding protein; blocks T cell activation and inhibits cytokine transcription.27
Mycophenolate mofetilPurine synthesis inhibitor by inhibiting IMP dehydrogenase.27
AnakinraIL-1 antagonist.
TocilizumabIL-6 receptor antagonist.
Infliximab, adalimumab, certolizumab pegol and othersTNF-α inhibitor.
Tofacitinib, baricitinib and othersInhibitor of JAK, which transmit extracellular data to the cell nucleus influencing DNA transcription.

  • IL, interleukin; JAK, Janus kinase; TNF-α, tumour necrosis factor-α.