What are the disease modifying anti-rheumatic drugs (DMARDS) for RA?

Disease-modifying antirheumatic drugs (DMARDs) are medications that slow the progression of rheumatoid arthritis. DMARDs are considered the gold standard for treating rheumatoid arthritis and may be used on their own or in combination with NSAIDs, corticosteroids, or other DMARDs.

The term DMARDs refers to a broad category of drugs that can be divided into two classes: chemical DMARDs; and the newer biologic DMARDs, also called biologics or biologic response modifiers. All DMARDs aim to readjust the overactive immune response that characterizes rheumatoid arthritis, but the main difference between the two classes is that chemical DMARDs affect the larger immune system, while biologics target specific immune cells.

Commonly used chemical DMARDs include:

• Methotrexate (Rheumatrex)
• Leflunomide (Arava)
• Hydroxychloroquine (Plaquenil)
• Sulfasalazine (Azulfidine)
• Azathioprine (Imuran)
• Minocycline (Minocin)

The biologic DMARDs currently approved to treat rheumatoid arthritis are:

• Adalimumab (Humira)
• Certolizumab pegol (Cimzia)
• Etanercept (Enbrel)
• Infliximab (Remicade)
• Abatacept (Orencia)
• Rituximab (Rituxan)
• Anakinra (Kineret)

Early, aggressive treatment with these powerful drugs may prevent damage to joints, bones, and other parts of your body, and they may slow or even halt the progress of rheumatoid arthritis. Intensive treatment with DMARDs requires regular monitoring to check how well the treatment is working and to make adjustments as needed.

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Also called slow-acting antirheumatic drugs or second-line drugs, DMARDs help alter the course of rheumatoid arthritis (RA) and prevent joint and cartilage destruction. They can produce significant results. You may need to wait weeks -- even months -- before seeing any effect, and you may use some or all of these, depending on the specifics of your condition. In some cases, one DMARD is used by itself. In other cases, more than one DMARD may be prescribed at the same time. You may have to try different medicines or combinations to find one that works best with the fewest side effects.

The most common DMARDs are: methotrexate (Rheumatrex, Trexall), sulfasalazine (Azulfidine), hydroxychloroquine (Plaquenil), leflunomide (Arava), cyclosporine (Sandimmune, Neoral), and minocycline (Dynacin, Minocin). Less commonly used is azathioprine (Imuran, Azasan). People taking methotrexate and most other DMARDs need periodic monitoring to make sure that toxicity to the liver or bone marrow does not occur. Although there is clearly a potential for toxicity of a powerful drug like methotrexate, it actually has a remarkable safety profile in RA and can be taken continuously for many years. Side effects of DMARDs vary greatly, but may include nausea or vomiting, diarrhea, heartburn, high blood pressure, sun sensitivity, rash, temporary hair loss, damage to the retina, liver or kidney damage, lung infections, and bone marrow suppression.

Pay attention to how your body responds to these drugs. Not only do you need to make sure the medications are effective (since efficacy can occasionally diminish over time), you also need to be alert to any problems arising from the drugs.