Luflunomide
				Arava is a  drug that works in a similar fashion to  methotrexate and is similar  in both response, and potential side effect. It  inhibits the inflammatory  cascade. It has similar precautions, especially  against use in   pregnancy, or for several months before planning on pregnancy. It  also has some problems associated with liver toxicity and requires  monitoring.  The drug however is effective with response over 3-4  weeks, and has been shown  to reduce erosions of the bone and joints.  It reduces structural deterioration.  This is therefore a major  advantage in management of RA. Dose requires a loading  dose of  100mg daily for 3 days and then a maintenance of 20mg per  day. Monitoring requires at minimum baseline FBC, AST,  ALT, GGT and pregnancy testing as required. The bloods should  be repeated at 1  month then two monthly. Overdose or side effect  may be treated using   cholestyramine. Main side effects  include Nausea Rash Alopecia Hepatic  enzyme elevation /  hepatitis Anaemia, leukopenia, Thrombocytopenia