Disease-Modifying Antirheumatic Drugs (DMARDS) are a group of medications, best known for treating rheumatoid arthritis. They decrease inflammation and pain, reduce tissue damage and slow disease. DMARDs include older drugs and newer biologic DMARDs that better target disease. Your treatment plan will include a checkup schedule to review progress and watch for side effects.
Disease-modifying antirheumatic drugs (DMARDs) are a group of medications that decrease inflammation and pain.
They are often called immunosuppressants or immunomodulators because these medications hold back or change how your immune system — your body’s defense system — works.
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DMARDs are most commonly known for treating rheumatoid arthritis, but also treat:
DMARDs work in several different ways. All work to hold back your body’s immune system. In an autoimmune disease, such as rheumatoid arthritis, your body’s immune system goes awry. Instead of attacking a foreign invader (such as an infection), it mistakenly attacks your body’s healthy tissues.
DMARDs work by:
There are two main groups of DMARDs, traditional DMARDs and biologics.
These are the older traditional or conventional DMARDs. Your provider may prescribe one of these medications first. Examples that represent this group include:
Biologics are DMARDs that are made using molecular biology. They are made up of proteins. Biologic DMARDs target specific molecules, cells and pathways that cause inflammation and damage tissue. They are more effective than traditional DMARDs.
Your provider may prescribe a biologic if your disease and symptoms didn’t improve on a traditional DMARD or if you had bothersome or serious side effects to those drugs.
There are subcategories of biologics. All target a specific molecule involved in inflammation and joint destruction.
Biologic DMARDs include:
Traditional DMARDs are usually taken by mouth (orally). Biologic DMARDs are given by injection (shot) or infusion (IV into a vein). The exception is the Janus kinase inhibitor biologics. These medications come in pill form and are taken by mouth.
You won’t get immediate pain and inflammation relief when you first take DMARDs. Traditional DMARDs can take a month or more to start working. Biologics and Janus kinase inhibitors usually begin to work after several weeks for some and four to six weeks for others.
You and your healthcare provider will discuss many factors before deciding if a DMARD is an option for your condition.
Some factors include:
Your healthcare provider may also ask you if:
Your healthcare provider may prescribe DMARDs as:
Your healthcare provider may start you on a traditional DMARD if you have mild to moderate disease. If your disease and symptoms don’t improve enough after a few months, your provider may increase the dosage or may switch to a different DMARD or add one or more DMARDs including a biologic DMARD to your treatment plan.
You and your provider will work together to find the best DMARD or combination of medications that work the best and have the fewest side effects.
Before starting a DMARD, your healthcare provider may:
Before you start treatment and while you’re taking DMARDs, you’ll also:
Your provider may order other tests depending on the specific DMARD you are taking. DMARDs have some side effects that are unique to each medication. In general, your provider will check you at least twice a year and perhaps more often for certain tests.
The results help your provider decide if they need to change your dose, change to a different DMARD, add another DMARD to your treatment plan or stop a DMARD.
Side effects depend on the type of DMARD you are taking. Each DMARD has some side effects that are unique to it.
Common side effects of traditional DMARDs include:
Common side effects of biologic DMARDs include:
Many more side effects are sometimes seen with DMARDs. Many are specific to an individual DMARD. You and your provider will discuss all side effects that are possible for the medications that may be options for you. Once you start treatment, never hesitate to talk with your provider if you develop a side effect that bothers you.
Some DMARDs can cause serious side effects in some people. This is one reason why your provider wants to check your blood on a regular, ongoing basis.
You shouldn’t take DMARDs — especially biologic DMARDs — if:
Your healthcare provider will carefully collect and review your medical history and the results of tests to make sure DMARDs are an appropriate treatment option for you.
Your healthcare provider can best answer this question. Your specific disease, how severe it is, your other health issues, the specific DMARD(s) you’re taking, and other medications you’re taking are all factors.
In general, DMARDs are a major treatment advance, especially for inflammatory autoimmune diseases such as rheumatoid arthritis. Biologic DMARDs are even more precise than traditional DMARDs in targeting disease.
DMARDs don’t cure or prevent disease. There is also a risk of serious side effects. But you are more likely to achieve a better outcome on DMARDs than on older generation medications.
Moving forward, scientists are working on how to better pair medications with your genetic profile (an approach called precision medicine or personalized medicine). This will allow the best possible outcome with the fewest side effects.
Be sure to ask:
Call your provider if you have:
Call your provider if you develop any side effect that bothers or worries you. Also, call if you are considering becoming pregnant or if you are pregnant.
A note from Cleveland Clinic
DMARDs are a class of drugs that treat rheumatoid arthritis and many other autoimmune disorders. You and your healthcare provider will review all the medication options and make the best choice for you. Each medication is unique with distinct side effects that need to be carefully checked. Your provider may adjust your dose, change DMARD or add other DMARDs to your treatment. Ask your provider about all the side effects of the particular medication you’ll be taking and what to watch for as you begin treatment with a DMARD.
Last reviewed by a Cleveland Clinic medical professional on 04/07/2022.
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