DISEASE - MODIFYING
ANTI - RHEUMATIC DRUGS
Disease-modifying antirheumatic drugs (DMARDs) decrease or stop joint damage caused by Rheumatoid Arthritis (RA) and other conditions and diseases and can often preserve use of joints. Some DMARDs were developed to treat RA, but others originated as drugs to treat cancer or malaria or to prevent rejection of organ transplants.
DMARDs work by suppressing the body’s immune and/or inflammatory systems to slow down or stop the progression of the condition being treated. However, how exactly this is accomplished is not known. DMARDs are usually taken orally but can also be injected.
Because of the potential for serious side effects, in the past this group of drugs was used as a second option against RA when less potent drugs, such as aspirin or other NSAIDs, had proven ineffective. However, research has shown that people with RA treated earlier with DMARDs tend to have better long-term results, greater mobility and a smaller risk of premature death. As a result, today DMARDs are often prescribed early in the course of the disease. Research has also shown that the combination of DMARDs started earlier has been beneficial in reducing joint damage, pain and swelling in patients with rheumatoid arthritis.
Treatment for RA usually begins within about three months of the onset of the disease to help prevent joint damage before it begins. DMARDs often help prevent much of this damage while also reducing pain, inflexibility and helping maintain physical mobility. Because their effectiveness may diminish over time, patients may be prescribed several different DMARDs over the course of the disease.
DMARDs are not designed for immediate relief and may not work for everyone. They often take several weeks or months of treatment before the effects are noticeable. Therapy with DMARDs may cause arthritis to go into remission, but the disease often recurs once treatment is stopped. As a result, patients may be encouraged to continue the use of DMARDs even if the progression of RA has ceased. Recent research suggests that patients who respond poorly to a DMARD initially can have better results when retrying the drug later.
Patients are often prescribed DMARDs in combination with other immunosuppressives, such as tumor necrosis factor (TNF) inhibitors or other biologic response modifiers (BRMs). Other medicines, such as NSAIDS, corticosteroids or other analgesics, may be used along with DMARDs to help alleviate symptoms, though DMARDs may make the need for their use less frequent. Combinations of DMARDs may be used over the long term, with adverse effects being no more common than when only one DMARD is used for treatment.
The Most Commonly
Administered DMARDs Include:
Other DMARDs include chlorambucil (Leukeran) and cyclosphosphamide (Cytoxan), which are used mainly to treat cancer, and mycophenolate (CellCept), which is used mainly to prevent rejection of a transplanted organ. They may sometimes be prescribed for severe renal or other organ disease.
Tumor necrosis factor (TNF) inhibitors such as adalimumab (Humira), etanercept (Enbrel) and infliximab (Remicade) are sometimes grouped in with DMARDs but generally are considered to be part of a related class of immunosuppressive drugs called biologic response modifiers (BRMs). They also treat conditions such as RA and psoriatic arthritis, and their benefits and risks may be similar to those of DMARDs.
How To Use Them
Disease-modifying antirheumatic drugs (DMARDs) may harm fetal development. Consequently, sexually active men and women using DMARDs should use effective means of contraception during every sexual encounter. In most cases, women who are pregnant or breastfeeding or who may become pregnant are advised not to take DMARDs.
In addition, it is important to note that some DMARDs may decrease the effect of birth control pills (oral contraceptives). Patients using these contraceptives are advised to ask their physician about alternate methods of birth control.
DMARDs are acceptable for children in certain circumstances, such as juvenile rheumatoid arthritis or organ transplantation, but children are monitored closely for possible side effects. Occasionally, lower doses of DMARDs may be required for elderly individuals. However, they generally are at no greater risk for side effects than younger adults.
Diseases & Conditions
Disease-modifying antirheumatic drugs (DMARDs) may be used independently or in combination with other drugs to treat various diseases, including:
used to prevent rejection of transplanted organs.
Conditions Of Concern
Disease-modifying antirheumatic drugs (DMARDs) each have different chemical properties. Accordingly, DMARDs may respond differently depending on the condition being treated, the drug being used, the dosage and characteristics of the patient.
In general, patients are encouraged to drink a lot of fluids to increase urine output. Prolonged exposure to sunlight should be avoided when DMARDs are prescribed, including the use of a highly protective sunscreen. In addition, because DMARDs may affect the immune system, proper oral hygiene will help prevent mouth infections from occurring.
Potentially serious side effects or reduced effectiveness of
DMARDs may occur in patients with any of the following conditions:
The potential benefits of disease-modifying antirheumatic drugs (DMARDs) should be weighed against possible side effects. The condition being treated will influence the choice and dosage of DMARDs. A physician should be consulted regularly during any treatment program involving DMARDs.
Patients who regularly use DMARDs are often carefully monitored for side effects in several ways, such as blood tests, urine tests, eye exams and chest x-ray. Depending on the disease, the DMARDs prescribed and the overall condition of the patient, certain side effects may occur. They include:
Many drug interactions with disease-modifying antirheumatic drugs (DMARDs) exist. Patients are encouraged to consult a physician before taking any additional prescriptions, over-the-counter medications, nutritional supplements or herbal medications.
Patients are advised to discuss with a physician whether vaccines should be administered when taking DMARDs. In addition, several DMARDs may cause an increase in sun sensitivity. Eating grapefruit or drinking the juice should be avoided before or after taking the DMARD cyclosporine. Recent research also suggests that pomegranate juice may affect some medications like grapefruit juice does. Use of antacids at the same time as sulfasalazine is not recommended.
Some types of medication may reduce the effectiveness or cause side effects in patients taking DMARDs, depending on the situation of the patient. They include:
Carpal Tunnel Syndrome
Lyme Disease -
Mixed Connective Tissue Disease - MCTD
Related to Arthritis
Raynaud's Phenomenon - Raynaud's Disease
Restless Legs Syndrome
Temporomandibular Joint Disorders - TMJ - TMD
Basal Joint Arthritis
Diffuse Idiopathic Skeletal Hyperostosis - DISH
Giant Cell Arteritis
Infectious Arthritis - Septic Arthritis
Joint Hypermobility Syndrome
Reactive Arthritis - Reiter's Syndrome
Adenoma - Acromegaly
Tendinitis - Tendonitis
Tuberculous Arthritis - Granulomatous Arthritis
The modification date for all health, and medical content on this page was last updated, and checked on June 12th, 2018 PST U.S.A.