What Are DMARDs and How Do They Treat Rheumatoid Arthritis?

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So when we think about arthritis treatment and once we get beyond the first level, the second level are disease-modifying antirheumatic drugs or DMARDS. Now that includes chemotherapies like methotrexate, really are gold standard, it includes plaquenil or hydroxychloroquine, a medicine that actually was initially used against malaria, but it is really very effective for decreasing inflammation, not quite as effective as methotrexate. So if you have definite inflammation but not quite bad enough to take methotrexate, sometimes we use hydroxychloroquine or plaquenil. There are other medicines that are used in transplant anti-rejection like cellCept, mycophenolate, [xx] is the generic for that.

Azothioprine another chemotherapy which is also known Imuran. So those are all medicines that we had for decades, really, to use for Rheumatoid arthritis and those are what we call our disease modifying anti-rheumatic drugs. In the late 90s, we got what people would call a biologic demard[sp?] or biologic response modifier which are medications that actually affect just one particular type of protein.

Oftentimes that protein is called TNF or IL6 or IL1, they always have letters that go along with them, one of my patients taught me that TLA's three letter acronym, seems like everything we that treat has a three letter acronym. So TNF, there are about five different medicines that treat TNF which is a protein that promotes inflammation.

So if you block that protein, you block the inflammation, most those medicines are given intravenously or intramuscularly or subcutaneously so they are almost always shots, the other ones, IL6, is in infusion as well which means that you have to have an IV given to you, and then we have different things that will block different types of cells the b cell there is one called arincio[sp?] that will block a B cell, I'm sorry, a T cell one called the rituximab which will block a B cell and then a new one called xellgens which blocks excess protein within the cell, called Jack [xx].