Treating Rheumatoid Arthritis With Disease-Modifying Drugs (DMARDs)

rheumatoid arthritis treatment can include medications that slow the progression of joint damage from rheumatoid arthritis. These drugs are called disease-modifying antirheumatic drugs (DMARDs), and they are an important part of an overall treatment plan. What are these drugs, and how do they work?

Disease-modifying drugs act on the immune system to slow the progression of rheumatoid arthritis. This is why they are called "disease-modifying." Many different medicines can be used as DMARDs in the treatment of rheumatoid arthritis, but some are used more often than others:

• Rheumatrex (methotrexate) is the most commonly used DMARD. This is because it has been shown to work as well or better than any other single medicine. It is also relatively inexpensive and generally safe. Like most DMARDs, methotrexate has side effects; it can cause stomach upset, can be toxic to the liver or bone marrow, and can cause birth defects. In rare cases, it can also cause shortness of breath.  Regular blood work is necessary when taking methotrexate.  Taking folic acid helps reduce some of the side effects. Methotrexate's biggest advantage might be that it has been shown to be safe to take for long periods of time and can even be used in children.
• Biologic drugs: Enbrel (etanercept), Humira (adalimumab), Kineret (anakinra), Orencia (abatacept), Remicade (infliximab), and Rituxan (rituximab). These are the newest drugs for rheumatoid arthritis, and are either injected under the skin or given directly into a vein. They work by neutralizing the immune system's signals that lead to joint damage. When used with methotrexate, these medicines help most people with rheumatoid arthritis. These drugs are thought to have fewer side effects than other DMARDs. One side effect is the risk for potentially severe infections. These medicines can also adversely affect your liver or blood counts and should be used with caution in patients with weak hearts (congestive heart failure).  Other potential long-term effects won't be known until the drugs have been used by patients for many years.
• Plaquenil (hydroxychloroquine) and Azulfidine (sulfasalazine) are used for mild rheumatoid arthritis. They are not as powerful as other DMARDs, but they usually cause fewer side effects. In rare cases, Plaquenil can adversely affect the eyes, and patients taking this medicine should be seen by an ophthalmologist at least once a year.
• Minocin (minocycline) is an antibiotic. But it may help RA by stopping inflammation. It can take several months to start working and up to a year before the full effects are known. When taken for long periods, minocycline can cause discoloration of the skin.
• Arava (leflunomide) works about as well as methotrexate and can work even better in combination with it. The side effects are similar to methotrexate. Sometimes Arava causes diarrhea and can't be used. Since Arava is known to cause harm to a fetus, women must take special precautions to not get pregnant while on it.
• Neoral (cyclosporine) is a powerful drug that often works well in slowing down joint damage. But because it can hurt the kidneys and has other potential side effects, it is usually used for severe rheumatoid arthritis after other drugs fail.
• Imuran (azathioprine) is used for many different inflammatory conditions, including rheumatoid arthritis. The most common side effects are nausea and vomiting, sometimes with stomach pain and diarrhea.  Long-term use of azathioprine is associated with an increased risk of cancer.

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