The Food and Drug Administration (FDA) has approved disease-modifying antirheumatic drugs (DMARDs) for managing various conditions, including:
- rheumatoid arthritis (RA)
- ankylosing spondylitis
- psoriatic arthritis (PsA)
- systemic lupus erythematosus
- juvenile idiopathic arthritis
- inflammatory bowel disease (IBD)
These medications suppress the immune system’s response to regulate inflammation. Healthcare professionals recommend starting DMARD therapy early to relieve joint pain and stiffness, preventing joint damage and deformity.
The use of DMARDs may differ depending on your condition and response to treatment.
What are DMARDs?
DMARDs, or disease-modifying antirheumatic drugs, are medications that doctors primarily use to treat inflammatory conditions such as PsA and RA.
DMARDs work by suppressing the body’s overactive immune and inflammatory systems. They help reduce inflammation and slow down the disease progression. These medications regulate the immune system in autoimmune diseases such as RA, where the immune system mistakenly attacks healthy tissues.
DMARDs are often called immunosuppressants and immunomodulators, meaning they can suppress certain components of the immune system while also managing their activity.
While traditional immunosuppressants broadly suppress the immune system, DMARDs have a more targeted and balanced approach. They regulate the overactive immune response in an autoimmune condition without fully suppressing it.
However, speak with a doctor to ensure the benefits of treatment outweigh any potential risks.
Types of DMARDs
There are three main types of DMARDs, which include:
Conventional DMARDs
Doctors commonly use conventional DMARDs. They suppress the immune system, reduce inflammation, and slow the progression of the autoimmune disease. You may take conventional DMARDs in pill or injection form. They are effective in managing symptoms and preventing joint damage.
Targeted synthetic DMARDs
Unlike conventional DMARDs, targeted synthetic DMARDs focus on certain molecules or pathways involved in inflammation. They work by stopping the function of enzymes or proteins responsible for the disease reducing inflammation and joint damage. You will usually take targeted synthetic DMARDs orally in the form of tablets.
Biologic DMARDs
Biologic DMARDs, also known as biologics, are a new class of medications that target specific immune system components. Living cells produce these drugs by binding to proteins or cells involved in inflammation. This binding helps reduce inflammation and slows down the disease progression.
Doctors administer biologics by injection or intravenous (IV) infusion. Biologics are highly effective in managing symptoms and improving the quality of life in people with autoimmune conditions.
While DMARDs can effectively treat autoimmune diseases, they may have potential side effects and require regular monitoring. The choice of DMARD depends on various factors, including the severity of the disease, individual characteristics, and other health conditions.
DMARDs vs. NSAIDs
While DMARDs and NSAIDs both manage inflammatory conditions, they have distinct roles and mechanisms of action. DMARDs are disease-modifying and target the immune system modifying disease progression, whereas NSAIDs reduce pain and inflammation. NSAIDs reduce your symptoms without modifying the disease progression.
Doctors use DMARDs for chronic inflammatory conditions that require long-term management. They will commonly use NSAIDs for temporary relief from symptoms. Sometimes, they may combine DMARDs and NSAIDs to achieve both disease modification and relief from symptoms, which is a more holistic management strategy.
Side effects and risks of DMARDs
Possible side effects of DMARDs include:
- gastrointestinal symptoms like nausea, vomiting, diarrhea, or stomach pain
- increased liver enzyme levels
- increased risk of infections
- low blood cell counts
- skin reactions such as rashes or light sensitivity
You can manage these side effects by taking the medication with food, adjusting the dosage, or seeking medical attention. Doctors also recommend regular monitoring of liver function and blood cell counts during DMARD treatment.
DMARD effects
While DMARDs can effectively manage inflammatory conditions, some important points that you need to consider before starting the treatment include:
- Active infections: As DMARDs suppress the immune system, they can increase the risk of infections. Due to this risk, a healthcare team will take extra care to look for active infections.
- Liver or kidney disease: Certain DMARDs can affect liver or kidney function. If you have a history of liver or kidney disease, your doctor will analyze your condition before starting DMARD therapy.
- Blood disorders: DMARDs can sometimes affect your blood cell production, leading to anemia or blood clotting conditions.
- Pregnancy or breastfeeding: Some DMARDs can affect fetal development, or you may pass on the effects of DMARD medication to the baby through breast milk.
Interactions and precautions when taking DMARDs
When taking DMARDs, it’s important to be aware of possible interactions to ensure the safety and effectiveness of the treatment. These may include:
- Medication interactions: DMARDs may interact with other medications you’re taking, including over-the-counter drugs, supplements, and herbal remedies. This could alter their effect or increase the risk of side effects.
- Monitoring: Regular follow-up visits are important when taking DMARDs to monitor your response to treatment. Your doctor will assess for any side effects and adjust your dosage. However, the frequency of these visits can vary depending on your health condition and the medication you’re taking.
- Tapering: You may need to gradually taper from some DMARDs, particularly glucocorticoids like prednisolone (Orapred), to prevent potential withdrawal symptoms* or disease flare-ups. A healthcare team will determine whether tapering is necessary and guide you to ensure a safe transition.
- Vaccinations: Some DMARDs, especially biologic DMARDs, may affect common vaccines and prevent them from stimulating an immune response in your body. You may consider speaking with a doctor or healthcare professional about vaccines, including live vaccines, as they may need to time them appropriately or avoid them while you have treatment.
- Certain conditions: Doctors may screen for infections, such as tuberculosis or hepatitis B and C, prior to starting DMARD therapy.
*When your body develops a dependence on a drug like DMARD, you may experience physical and emotional symptoms, also called withdrawal symptoms, when you stop using the drug regularly.
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