NSAIDS can help patients with arthritis improve symptoms, reduce inflammation, and are very helpful for short-term disease control.

However, NSAIDS are not suitable for long-term use. Common side effects include:

• Stomach pain
• Gastric ulcers
• Kidney failure
• Liver function impairment
• Increased cardiovascular risk

Among NSAIDS, Selective COX-2 inhibitors are associated with fewer stomach-related side effects.

Steroids have anti-inflammatory and immunosuppressive effects, effectively reducing inflammation and immune-mediated damage to tissues. Therefore, they are essential in treating various inflammatory, pain, or autoimmune diseases in rheumatology.

Long-term steroid use, especially at high doses, can lead to various side effects or complications, including:

• Facial swelling
• Weight gain
• Cataracts, glaucoma
• Elevated blood pressure and blood sugar
• Osteoporosis
• Bone fractures
• Gastric ulcers
• Increased risk of infections
• Insomnia, nervous excitement
• Bruising

Despite these potential issues, steroids remain very important in controlling autoimmune diseases and arthritis. When used appropriately, they can significantly help in disease management and improving quality of life.

DMARDs can gradually replace steroids in controlling autoimmune diseases, continuously improving disease conditions. Common medications include:

• Hydroxychloroquine (Plaquenil)
• Sulfasalazine
• Methotrexate
• Leflunomide
• Cyclosporin A
• Azathioprine
• Mycophenolate Mofetil

Biologics are antibody-based drugs developed through biotechnology. These antibodies selectively suppress overactive inflammatory cytokines within the patient’s body, thereby halting the chain reaction of inflammation.

In rheumatology, biologics such as anti-TNF, anti-IL6, anti-IL17, anti-IL23, and JAK inhibitors can effectively control moderate to severe disease, significantly improving patients’ lives and preventing long-term joint destruction caused by inflammation.

Biologics are more targeted and often more effective with fewer side effects compared to traditional DMARDs. Common side effects include:

• Infections
• Headache and fatigue (usually mild)
• Injection site inflammation
• Slight elevation in liver function tests

Before starting biologics (especially anti-TNF), doctors usually recommend screening for latent tuberculosis infection to reduce the risk of infection.

Oral targeted synthetic DMARDs, such as JAK inhibitors, are newer drugs that target specific pathways (like JAK enzymes). They are effective across various autoimmune diseases and offer the convenience of oral administration.

Currently, these drugs are used for:

• Rheumatoid Arthritis
• Ankylosing Spondylitis
• Psoriasis / Psoriatic Arthritis
• Atopic Dermatitis
• Inflammatory Bowel Disease
• Alopecia Areata (commonly known as “spot baldness” or “sudden hair loss”)

Side effects include infections and liver function impact. Oral JAK inhibitors may slightly increase the risk of shingles, so pre-treatment vaccination can be considered. In elderly patients or those with other risk factors, they may also slightly increase the risk of certain cancers and cardiovascular diseases; usage should follow medical advice.