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10.1016/j.febslet.2011.03.039 183 MintonD

When initial therapy proves insufficient, treatment escalation includes: Biologic DMARDs targeting specific inflammatory pathways (TNF inhibitors, IL-6 inhibitors, T-cell costimulation blockers, B-cell depleting agents) Targeted synthetic DMARDs such as JAK inhibitors (tofacitinib, baricitinib, upadacitinib), which carry FDA boxed warnings for serious cardiovascular events, malignancy, and thrombosis [24] [25] Combination DMARD therapy Short-term glucocorticoids for symptom control during treatment initiation Before starting biologic or targeted synthetic DMARDs, screening for tuberculosis and hepatitis B is recommended, along with appropriate vaccinations according to ACR guidelines

Dihexa targets a persons cognitive function specifically and produces chemicals that the brain requires to enhance memory

After discontinuation, meaningful plasma levels may persist for several weeks, which is clinically relevant for surgery, pregnancy planning, or new medication introduction

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