Overview
DMARDs slow down rheumatoid arthritis (RA), improving the quality of life for most people living with RA. Some patients experience a remission while taking these drugs, but more commonly, the disease activity continues at a slower pace.
When taking DMARDs, a patient may experience longer symptom-free periods, or flare ups that are less painful. Your joints may take less time to loosen up in the morning. Taking a DMARD regularly may also make you less likely to have long-term damage to your joints.
Disease-modifying drugs act on the immune system to slow the progression of rheumatoid arthritis.
Detailed Description
Many different medicines can be used as DMARDs in the treatment of RA, but the following are used most often:
Rheumatrex (methotrexate)
The most commonly used DMARD. It is generally safe, but some side effects include stomach upset, toxicity to the liver or bone marrow, and birth defects. Rarely, it can also cause shortness of breath. Regular blood work is necessary when taking methotrexate.
Advantages of this drug are that it has been shown to be safe when taken over long periods of time and can be used in children.
Biologic drugs: Enbrel (etanercept), Humira (adalimumab), Kineret (anakinra), Orencia (abatacept), Remicade (infliximab), and Rituxan (rituximab).
These drugs are either injected under the skin or given directly into a vein. They work by neutralizing the immune system's signals that lead to joint damage.
When used with methotrexate, these medicines help most people with rheumatoid arthritis. These drugs are thought to have fewer side effects than other DMARDs.
One side effect is the risk for potentially severe infections. These medicines can also adversely affect your liver or blood counts and should be used with caution in patients with weak hearts.
Plaquenil (hydroxychloroquine) and Azulfidine (sulfasalazine)
These are used for mild rheumatoid arthritis because they are not as powerful as other DMARDs. In rare cases, Plaquenil can adversely affect the eyes.
Minocin (minocycline)
This drug is an antibiotic that may help RA by stopping inflammation. It can take several months to start working and up to a year before the full effects are known. When taken for long periods, minocycline can cause discoloration of the skin.
Neoral (cyclosporine)
This is a powerful drug used in slowing down joint damage. It is used mainly in the most severe cases of RA, after other drug options have failed, because it can negatively affect the kidneys.
Side Effects
The DMARDs have several other potential side effects in common:
Stomach upset.
DMARDs often cause nausea, sometimes with vomiting, or diarrhea. Other medicines can help treat these symptoms, or they often improve as you get used to the drug.
Liver problems.
These are less common than stomach upset. Your doctor will check blood tests on a regular basis to make sure your liver is not being harmed.
Blood issues.
DMARDs can affect the immune system and raise the risk of infection. Infection-fighting white blood cells may also be decreased. Low red blood cells (anemia) can make you tired more easily. A simple blood test by your doctor every so often will make sure your blood counts are high enough.
Last updated: 01-Jan-00
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