What are DMARDs?

DMARDs stand for disease-modifying antirheumatic drugsit’s a category of commonly used drugs to slow the progression of joint damage from rheumatoid arthritis, it’s a part of rheumatoid arthritis treatment.  

Usually, the more powerful DMARDs cause more side effects, and vice versa. 

What are commonly used and safer DMARDs?

Hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine) are used for mild rheumatoid arthritis. They are not most powerful, but cause fewer side effects. In rare cases, Plaquenil can adversely affect the eyes, and patients taking this medicine should be seen by an ophthalmologist at least once a year.

Methotrexate is almost the best performer in DMARD category, and relatively inexpensive and generally safe. Methotrexate has side effects though, including rash, stomach upset, being toxic to the liver or bone marrow, causing birth defects. In rare cases, it can also cause shortness of breath. Patients taking methotrexate need regular blood check. Taking folic acid helps reduce some of the side effects. Methotrexate has been used for a relatively long period of time and can even be used in children.

Leflunomide (Arava) works about as well as methotrexate and can work even better in combination with it. The side effects are similar to methotrexate. Sometimes, Arava causes diarrhea and can’t be used.  Arava is known to cause harm to a fetus, so it’s not used in women pregnant or planning for pregnancy.

Minocycline (Minocin) is an antibiotic that is not often prescribed. But it may help RA by stopping inflammation. Long time usage of minocycline can cause discoloration of the skin.

Azathioprine (Imuran) is used for many different inflammatory conditions, including RA. The most common side effects are nausea and vomiting, sometimes with stomach pain and diarrhea. Long-term use of azathioprine is associated with an increased risk of cancer.

What to use when common drugs fail?

Cyclosporine (Neoral ) is a powerful drug in slowing down joint damage. One of the side effects is hurting kidney function. Because of that, it is usually used for severe RA after other drugs fail. 

Tofacitinib (Xeljanz) is a type of drug called a JAK inhibitor. It is often used in people who no longer respond to methotrexate. The drug inhibits immune responses, which means it raises the risk of serious infections, cancers, and lymphoma. The drug will carry a “black box” warning about these risks.

What are newest?

Biologic drugs are the newest drugs for RA and are usually injected. They work by neutralizing one of the immune system’s signals (TNF) that lead to inflammation and joint damage. Biologic drugs with methotrexate can help most people with rheumatoid arthritis. These drugs are thought to have fewer side effects than other DMARDs. Side effects include effect on liver or blood counts but rarely, risk for potentially severe infections. Biologic drugs are new so they’re not used for many years. Some long-term effects won’t be known until many years later. This could be another risk. Biologic drugs are mainly:

  • abatacept (Orencia)
  • adalimumab (Humira)
  • anakinra (Kineret)
  • certolizumab (Cimzia)
  • etanercept (Enbrel)
  • etanercept-szzs (Ereizi)
  • golimumab (Simponi, Simponi Aria)
  • infliximab (Remicade).



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