DMARDs: Powerful Rheumatoid Arthritis Drugs to Stop or Slow Joint Damage

All Rights Reserved

Rheumatoid arthritis (RA) is a chronic inflammatory disease that usually affects the joints. Although doctors can't yet cure it, many treatments are available to help control the inflammation. Early control of inflammation is especially important, since it helps prevent permanent damage to the body's joints. It also usually helps you feel better.

To control inflammation, doctors often use medications called disease-modifying antirheumatic drugs (DMARDs). While these medications can work wonders in getting rheumatoid arthritis under control, they require close follow-up and can have serious side effects. For this reason, it's usually necessary for people with rheumatoid arthritis to be under the care of a rheumatologist, a specialist in joint and autoimmune diseases. With enough treatment, many people enter a clinical "remission," in which the disease becomes inactive and the joints stop feeling painful.

To decide which medication to use, your doctor will start by assessing the current stage and activity of your rheumatoid arthritis. Your doctor will also consider any current or previous medications that you've tried and factor in any other medical conditions you have.

DMARDs come in two basic flavors: non-biologic and biologic.

Non-biologic DMARDs

In mild early rheumatoid arthritis, commonly used DMARDs include:

  • Hydroxychloroquine. Hydroxychloroquine is an antimalarial drug that also helps decrease inflammation in rheumatoid arthritis. Serious side effects are rarer than with some of the other DMARDs. As this drug is less potent than others, it's sometimes combined with another DMARD.

  • Sulfasalazine. Sulfasalazine is an anti-inflammatory that's also used for the treatment of inflammatory bowel disease.

  • Minocycline. Minocycline is related to the antibiotic tetracycline. It's used less often than hydroxychloroquine or sulfasalazine.

More potent non-biological DMARDs used for more active or persistently active rheumatoid arthritis include:

  • Methotrexate. Methotrexate is often the first drug used for moderately active rheumatoid arthritis; it's also used -- in higher doses -- to treat certain cancers. Methotrexate interferes with the metabolism of certain compounds within the body's cells. Because it can affect the liver, you shouldn't drink alcohol while being treated with methotrexate. Methotrexate also can't be used during pregnancy.

  • Leflunomide. Leflunomide interferes with the body's production of cells involved in the inflammatory response. It's often used for patients who don't respond to or can't tolerate methotrexate.

  • Azathioprine. Azathioprine is used to treat certain cancers and after certain organ transplants. It's sometimes used in patients with rheumatoid arthritis if other treatments haven't worked.

  • Cyclosporine. Like azathioprine, cyclosporine is a potent immune-suppressing medication that inhibits cells involved in the inflammatory response. It was first developed for use after organ transplants.

Biologic DMARDs

Biologic DMARDs are unique drugs produced through recombinant DNA technology. They have a structure similar to the body's own antibodies, and they target cytokines, components in the body's inflammatory response.

Many biologic DMARDs are in a class known as "tumor necrosis factor (TNF) inhibitors." These include etanercept, adalimumab, infliximab, certolizumab pegol, and golimumab. TNF inhibitors are sometimes used in combination with methotrexate or another non-biologic DMARD.

Other biologic DMARDs are anakinra, tocilizumab, abatacept, and rituximab. All biologic DMARDs must be injected or infused.

Biologic DMARDs can be highly effective but can also cause serious side effects such as infections, low white blood cell counts, and reactivation of tuberculosis. They're usually only tried after non-biologic DMARDs have failed. It's important to confirm that a person doesn't have tuberculosis before starting one of these drugs.

DMARDs are the mainstay of treatment for active rheumatoid arthritis, since only DMARDs can prevent the permanent joint damage caused by ongoing inflammation in the joints. However, other medications may be used to help manage pain, especially since DMARDs often take weeks to work.

For more information on medications used to treat rheumatoid arthritis, see Medications Used to Treat Rheumatoid Arthritis.

For non-drug therapies to help manage rheumatoid arthritis, see 7 Natural Ways To Manage Your Rheumatoid Arthritis Symptoms.

Dr. Leslie Kernisan

Leslie Kernisan is a clinical instructor in the University of California, San Francisco, Division of Geriatrics, and maintains a popular blog and podcast at BetterHealthWhileAging. See full bio