Disease-Modifying Antirheumatic Drugs (DMARDS)

What are DMARDS?

Disease-modifying antirheumatic drugs (DMARDs) are prescription medications that calm down your immune system when it’s overly active. Healthcare providers sometimes call DMARDS antirheumatic drugs or disease-modifying drugs.

If you have an autoimmune disease, your immune system attacks your body instead of protecting it. DMARDS are a type of immunosuppressant that regulates your immune system and stops it from damaging tissue in your body.

DMARDS can:

• Decrease inflammation
• Relieve pain
• Slow down how quickly some conditions spread (or become more severe)
• Reduce or prevent how much a condition damages your bones and joints
• Help maintain how well you can use your joints (preserve your joint function)

Which conditions do DMARDS treat?

Healthcare providers use DMARDS to manage several autoimmune conditions that cause inflammation, including:

• Rheumatoid arthritis
• Ankylosing spondylitis
• Psoriatic arthritis
• Lupus
• Juvenile idiopathic arthritis
• Scleroderma
• Multiple sclerosis
• Sjögren’s syndrome
• Myositis
• Rheumatoid vasculitis
• Inflammatory bowel disease
• Crohn’s disease

It’s less common, but you may need a DMARD to treat certain kinds of cancer. Providers also sometimes use them to manage uveitis that’s not from an infection and hasn’t gotten better after other treatments.

What are the types of DMARDS?

There are two main groups of DMARDs — traditional DMARDS and biologics.

Traditional DMARDS

Traditional DMARDS broadly target your whole immune system. Your provider may prescribe one of these medications before trying biologics because they usually cause fewer side effects. Traditional DMARDS are usually pills you take by mouth (orally).

Examples of traditional DMARDS include:

• Azathioprine
• Hydroxychloroquine
• Leflunomide
• Methotrexate
• Sulfasalazine

Biologics

Biologics are made of proteins that target a specific set of immune system cells. They’re usually more effective than traditional DMARDS, but are stronger and can have a higher risk of causing side effects.

Your provider may prescribe a biologic if you’ve tried traditional DMARDs and they didn’t work well. You’ll probably take biologics via an intravenous (IV) infusion — your provider will inject the medication into one of your veins. You may also use an injection you give yourself under your skin (a subcutaneous self-injection). Your provider will show you how to give yourself an injection correctly and safely.

There are several subcategories of biologics. They each target different parts of your immune system. Some biologic DMARDs include:

• Tumor necrosis factor (TNF) inhibitors
• Interleukin inhibitors
• T-cell inhibitors
• B-cell inhibitors
• Janus kinase inhibitors (medications that aren’t technically biologics but work in a similar way — they target a specific set of immune cells)

What are the benefits of taking DMARDS?

DMARDS can effectively treat lots of different conditions. They can help you manage symptoms like pain and inflammation that make it hard to move or do all your usual activities. They can also slow down and prevent damage inside your body that you might not be able to see or feel.

DMARDS are very flexible. They can work in lots of combinations (including with other medications). For example, your provider may prescribe you:

• A single traditional DMARD
• A single traditional DMARD combined with a corticosteroid, or other medications
• Two or more traditional DMARDs
• A traditional DMARD alongside a biologic

Your provider will work with you to find the right DMARD or combination of medications that work the best and have the fewest side effects.

Do DMARDS have side effects?

Which side effects you might experience will depend on which type of DMARD you need.

Both types of DMARDS share some potential side effects, including:

• An increased risk of infections (biologics have a higher risk of this)
• Low white blood cell count (leukopenia)
• Low red blood cell count (anemia)
• Low platelet count (thrombocytopenia)
• Elevated liver enzymes

Traditional DMARD side effects can also include:

• Loss of appetite
• Nausea and vomiting
• Diarrhea
• Abdominal pain
• Skin rash

Other side effects of biologic DMARDS can include:

• Reactivation of chronic (long-term) infections you have, including tuberculosis, herpes or hepatitis
• Elevated cholesterol
• Increased risk of blood clots
• Infusion or injection site reactions

Talk to your provider about the risk of experiencing side effects before you start DMARDS. They’ll help you understand what to watch out for.

How quickly do DMARDS work?

It usually takes at least a few weeks for DMARDS to start regulating your immune system and managing symptoms. You won’t get immediate pain or inflammation relief when you first take them. Traditional DMARDs can take a month or more to start working. Biologics usually begin to work after several weeks.

When should I see my healthcare provider?

Your provider will tell you how often you’ll need follow-up appointments after you start or change DMARDS. You might need some regular tests, including:

• Blood tests to make sure the medications are working and to check for signs of side effects
• Tests to monitor for infections (especially if you have a chronic infection)
• Imaging tests like X-rays to monitor changes in your joints

Talk to your provider if you notice any new or more severe side effects. Tell them if it feels like you’re experiencing symptoms or side effects more often, or if it feels like your medication isn’t working as well as it used to.