What Are Disease-Modifying Antirheumatic Drugs (DMARDs)?

Disease-modifying antirheumatic drugs (DMARDs) are inflammation-blocking medications used as part of a treatment plan for several health conditions associated with joint damage. DMARDs are used to stop or slow the progression of joint damage associated with certain health conditions, such as rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, juvenile idiopathic arthritis and lupus. Without DMARDs, the inflammation caused by these health conditions would slowly destroy joint tissue, resulting in joint immobility.

While these conditions do not have a cure, a combination of medications, self-care and other therapies can protect the joints and even lead to remission. Disease-modifying antirheumatic drugs usually take three to six months to fully control symptoms. Blood tests and baseline X-rays are ordered before prescribing DMARDs. It is important to remember these are not pain medications; however, pain symptoms will decrease as inflammation and joint tenderness lessen.

Types of DMARDs

Two main types of disease-modifying antirheumatic drugs are available: conventional (traditional) and biologic (targeted). Conventional DMARDs reduce systemic inflammation. Biologic DMARDs target specific inflammation-causing molecules in the immune system. Oftentimes, a combination of conventional and biologic DMARDs are prescribed as an aggressive treatment.

Conventional DMARDs

• Methotrexate is the most common conventional DMARD and comes in tablet or self-injectable form. It is often prescribed for adults with active rheumatoid arthritis (RA) and children with active juvenile idiopathic arthritis, if more than one joint is affected.
• Azathioprine is available only in tablet form and is most commonly used to treat lupus. This drug requires prior testing to ensure a specific enzyme is present in the body in order to effectively work.
• Cyclophosphamide is available in capsule, tablet or infusion form. It may be used when lupus does not respond to traditional therapy.
• Cyclosporine comes in a capsule or syrup. It may be used when lupus does not respond to other therapies.
• Hydroxychloroquine sulfate is available only in tablet form. It is an antimalarial drug and is commonly used to treat RA. Hydroxychloroquine sulfate helps to prevent organ damage and delay disease recurrence. It can also improve lupus-related skin lesions.
• Leflunomide comes in pill form, usually taken once a day. It can be taken alone or in combination with methotrexate.
• Mycophenolate mofetil is available in tablet, capsule or self-injectable form. This drug may be prescribed when rheumatoid arthritis does not respond to other therapies.
• Sulfasalazine is available in regular or extended-release tablets. This drug is typically used in a triple-therapy combination for rheumatoid arthritis (methotrexate, sulfasalazine and hydroxychloroquine).

Biologic DMARDs

• Apremilast is available only in tablet form. This medication is prescribed for psoriatic arthritis.
• Tofacitinib is available in immediate or extended-release tablets. It is approved for rheumatoid arthritis treatment.

DMARDs are usually started in low dosages and adjustments are made depending on drug tolerance. If a combination of DMARDs is prescribed, health care professionals typically wait three months to test their effectiveness.

Side effects

A health care professional should be consulted if any side effects occur. Side effects include, but are not limited to, the following:

• Abdominal pain, nausea, vomiting or diarrhea
• Hair loss
• Painful urination
• Fever or chills
• Sore throat
• Mouth sores
• Rash
• Lung problems
• Sensitivity to sunlight
• Suppressed immune system
• Increased bacterial or viral infections
• Liver problems
• Blood-related issues

Although the benefits of DMARDs generally offset the potential side effects, a physician should be consulted if any side effects are experienced.