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Patient education: Disease-modifying antirheumatic drugs (DMARDs) (The Basics)

Patient education: Disease-modifying antirheumatic drugs (DMARDs) (The Basics)

What are disease-modifying antirheumatic drugs (DMARDs)? — These are medicines that partly turn off the body's infection-fighting system, called the "immune system." Doctors prescribe DMARDs for some diseases that happen when the immune system mistakenly attacks the body's own healthy tissues, such as the joints or kidneys. These are called "autoimmune" diseases. Examples include rheumatoid arthritis and psoriatic arthritis.

DMARDs are usually prescribed by a specialist doctor, such as a "rheumatologist." They are typically part of a long-term treatment plan.

What do DMARDs do? — They work by blocking the effects of the immune system when it attacks the joints or other parts of the body. DMARDs are a key part of treatment because they can slow the spread of the disease and reduce the damage it causes to the body over time.

Doctors usually start DMARDs soon after they are sure that you have an autoimmune disease that can cause damage to your joints. DMARDs slow or prevent joint damage and help keep your joints working better.

When do DMARDs start to work? — They take weeks or months to work. Doctors can prescribe other medicines along with DMARDs while waiting for the DMARDs to start working. These other medicines could be a "nonsteroidal antiinflammatory drug" ("NSAID"), such as naproxen, or a steroid, such as prednisone. These reduce stiffness and soreness.

Before starting a DMARD, your doctor might test you for tuberculosis and hepatitis. They might also check to see if you are up to date on your vaccines.

What are the different kinds of DMARDs? — There are 3 main types of DMARDs: "conventional synthetic," "biologic," and "targeted synthetic." Some of these are listed in the table (table 1).

Conventional synthetic DMARDs – Doctors usually prescribe these first. They include medicines usually taken as pills, such as methotrexate, leflunomide, sulfasalazine, and hydroxychloroquine.

Methotrexate is taken just 1 time per week, usually as a pill. Some people have been badly harmed by taking it too often. Always double-check the instructions with your doctor and pharmacist before you take methotrexate. Use a pill box and other reminders to make sure that you take it correctly only 1 time per week. Do not drink alcohol if you take methotrexate.

Biologic DMARDs – "Biologic" refers to the way these are made. They are taken by an injection (shot) under the skin or through a thin tube that goes into a vein, called an "IV." The IV medicines are given in a doctor's office or clinic over a half hour or longer. Some of the biologic DMARDs and how they are taken are listed in the table (table 1).

Usually, doctors prescribe biologic DMARDs only if you do not get better while taking conventional synthetic DMARDs for several months, or if you have bad side effects while taking other DMARDs. People usually take biologic medicines along with a conventional synthetic DMARD, such as methotrexate.

Some people should not take biologic DMARDs. For example, if you have a serious infection, certain blood cancers, or heart problems, your doctor will decide whether or not a biologic DMARD is a good choice for you.

Targeted synthetic DMARDs – These work like biologic DMARDs and have similar risks and side effects, but are taken as pills. They are a type of medicine called "JAK inhibitors." Although some people want to try these because they come in a pill instead of a shot, these medicines can have added risks. For this reason, your doctor might want you to try a shot or IV medicine first.

Will I need to use more than 1 DMARD? — Maybe. If your symptoms do not improve enough after a few months of treatment at a full dose, your doctor might switch your medicine. You might get a different DMARD or a combination of 2 or 3 different DMARDs.

What about side effects? — These depend on the specific DMARD you are taking. They are usually mild and might include loss of appetite, nausea, headache, or diarrhea. DMARDs can also cause serious side effects in a small number of people. You will need to see your doctor regularly to check for possible problems caused by DMARDs. This usually includes regular blood tests. Talk to your doctor or nurse about any side effects that bother or worry you.

How long will I need to take a DMARD? — If you are taking a DMARD and it is working well, your doctor might keep you on it for a while. This will help keep symptoms from flaring up and protect your body from being damaged by the disease.

To know how the medicine is working, your doctor can ask questions about how you feel, examine you, and order imaging tests. These create pictures of the inside of your body. Doctors can use them to see how your joints are doing, and then change your DMARD medicine or dose if needed. This is another reason why you should have regular appointments with your doctor when you are taking a DMARD.

Will I still have symptom flares after I start a DMARD? — Possibly. DMARDs can decrease how often symptoms "flare up" or get worse, and how severe the symptoms are. But in some cases, they cannot stop symptoms completely. If your disease flares up, your doctor might need to change your DMARD or adjust the dose. They might also need to give you additional medicines.

What if I want to get pregnant? — Many DMARDs are not safe to take when trying to get pregnant, during pregnancy, or during breastfeeding. Talk with your doctor if you or your partner could become pregnant.

For more detailed information about your medicines, ask your doctor or nurse for the patient drug information handout from UpToDate. It explains how to use each medicine, describes its possible side effects, and lists other medicines or foods that can affect how it works.

More on this topic

Patient education: Nonsteroidal antiinflammatory drugs (NSAIDs) (The Basics)
Patient education: Lupus (The Basics)
Patient education: Rheumatoid arthritis (The Basics)
Patient education: Psoriatic arthritis in adults (The Basics)

Patient education: Disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (Beyond the Basics)
Patient education: Nonsteroidal antiinflammatory drugs (NSAIDs) (Beyond the Basics)
Patient education: Systemic lupus erythematosus (Beyond the Basics)
Patient education: Rheumatoid arthritis treatment (Beyond the Basics)
Patient education: Psoriatic arthritis (Beyond the Basics)

This topic retrieved from UpToDate on: Jun 02, 2024.
Disclaimer: This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof. The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms. 2024© UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.
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