Disease-Modifying Antirheumatic Drugs (DMARDS) to Treat Rheumatoid Arthritis
What are DMARDs?
Disease-modifying antirheumatic drugs (DMARDs) are a group of drugs used to treat rheumatoid arthritis (RA). They can help slow down the progression of the disease and improve symptoms.
DMARDs are commonly grouped into conventional synthetic DMARDs (csDMARDs), biologic DMARDs (bDMARDs), and targeted synthetic DMARDs (tsDMARDs). Conventional synthetic DMARDs, such as methotrexate, leflunomide, sulfasalazine, and hydroxychloroquine, affect immune and inflammatory pathways in broader ways. Targeted synthetic DMARDs are small-molecule medicines that act on specific pathways inside immune cells. Biologic DMARDs are protein-based medicines that target specific parts of the immune system, such as inflammatory proteins or immune-cell signaling pathways.
Biologic DMARDs help reduce inflammation by blocking specific immune system signals or cells that contribute to joint swelling, pain, and damage in rheumatoid arthritis (RA). For example, some biologic DMARDs target tumor necrosis factor (TNF), interleukin-6 (IL-6), T-cell activation, or B cells.
Overall, DMARDs are a key part of RA treatment because they can reduce inflammation, improve symptoms, and help prevent or slow joint damage and disease progression. Current treatment guidelines recommend starting DMARD therapy soon after RA is diagnosed and adjusting treatment as needed to reach low disease activity or remission.
How do DMARDs work
How DMARDs work varies depending on the specific drug, but they all help reduce the immune-driven inflammation that causes joint swelling, pain, and damage in rheumatoid arthritis (RA).
Ways in which DMARDs may work include:
- Modulating the immune response:
DMARDs do not simply “turn off” the immune system. Instead, they help adjust or suppress parts of the overactive immune response that drive inflammation in RA. This can reduce joint inflammation and help protect joints from ongoing damage.
- Targeting inflammatory signals or immune cells:
Some DMARDs act on specific immune pathways. For example, biologic DMARDs may block inflammatory proteins such as TNF or IL-6, affect T-cell activation, or target B cells. Targeted synthetic DMARDs, such as Janus kinase (JAK) inhibitors, work inside cells to interrupt signaling pathways involved in inflammation.
Because RA inflammation involves many interacting immune cells and chemical messengers, the effects of DMARDs can extend beyond one single target. By reducing key inflammatory pathways, DMARDs may also lower the activity of other cytokines and immune signals involved in RA.
Overall, DMARDs play a crucial role in reducing disease activity and stopping the progression of rheumatoid arthritis. They help manage symptoms such as pain, physical functionality, and fatigue. While DMARDs have been effective in treating RA, there is still ongoing research to better understand their effects on both clinical symptoms and molecular mechanisms associated with the disease.
How to Use DMARDs
Disease-modifying antirheumatic drugs (DMARDs) are prescription medicines used to treat rheumatoid arthritis (RA) by reducing inflammation, improving symptoms, and helping prevent joint damage. They should be used under the care of a rheumatologist or another healthcare professional experienced in treating RA.
How to use DMARDs:
- Take DMARDs exactly as prescribed. Some are taken by mouth, while others are given as injections or infusions. The dose and schedule depend on the specific medication and your treatment plan.
- Do not stop, skip, or change your dose unless your healthcare professional tells you to. Stopping DMARDs suddenly may allow RA inflammation to return or worsen.
- Some DMARDs take several weeks or months to have their full effect. Your healthcare professional may adjust the dose or change medications if RA is not well controlled.
Precautions when using DMARDs:
- Before starting a DMARD, talk with your healthcare professional about the best option for you, including the expected benefits, possible risks, monitoring needs, and how long it may take to work.
- Certain DMARDs may not be suitable for people with specific medical conditions, infections, liver or kidney problems, low blood counts, or a history of certain cancers. Your healthcare professional will consider your health history and other medicines before prescribing a DMARD.
- Tell your healthcare professional about any allergies, previous medication reactions, current infections, pregnancy plans, or breastfeeding. Some DMARDs are not recommended during pregnancy or may need to be stopped before trying to conceive.
Side effects vary depending on the specific DMARD. Possible side effects or safety concerns may include:
- Nausea, vomiting, or loss of appetite
- Diarrhea or stomach upset
- Mouth sores or fatigue
- Skin rash or injection-site reactions
- Liver irritation or abnormal liver blood tests
- Low blood cell counts or bone marrow suppression
- Increased risk of infections, including serious infections with some biologic or targeted synthetic DMARDs
Contact your healthcare professional promptly if you develop signs of infection, such as fever, chills, sore throat, painful urination, or a new cough. Some DMARDs, especially biologic and targeted synthetic therapies, can be expensive, and insurance coverage may vary. Talk with your healthcare professional about any concerns, including cost, monitoring, vaccines, pregnancy planning, or side effects.