Disease-modifying antirheumatic drugs (DMARDs) are common arthritis medications. They relieve painful, swollen joints and slow joint damage, and several DMARDs may be used over the disease course. Exactly how they work is still unknown.
- DMARDs take a few weeks or months to have an effect, and may produce significant improvements for many patients.
- Side effects vary with each medicine. DMARDs may increase risk of infection, hair loss, and kidney or liver damage.
- Doctor monitoring allows the risk of toxicities to be weighed against the potential benefits of individual medications.
Azathioprine
Azathioprine was first used in higher doses in cancer chemotherapy and organ transplantation. It is used in patients who have not responded to other drugs, and in combination therapy. Possible side effects include cough or hoarseness, fever or chills, loss of appetite, lower back or side pain, nausea or vomiting, painful or difficult urination, unusual tiredness or weakness. Before taking this drug, tell your doctor if you use allopurinol or have kidney or liver disease. This drug can reduce your ability to fight infection, so call your doctor immediately if you develop chills, fever, or a cough. Regular blood and liver function tests are needed.
Cyclosporine
Cyclosporinewas first used in organ transplantation to prevent rejection. It is used in patients who have not responded to other drugs. Possible side effects include bleeding, tender, or enlarged gums; high blood pressure; increase in hair growth; kidney problems; trembling and shaking of hands. Before taking this drug, tell your doctor if you have one of the following: sensitivity to castor oil (if receiving the drug by injection), liver or kidney disease, active infection, or high blood pressure. Using this drug may make you more susceptible to infection and certain cancers. Do not take live vaccines while on this drug.
Hydroxychloroquine
It may take several months to notice the benefits of this drug, which include reducing the signs and symptoms of rheumatoid arthritis. Possible side effects include diarrhea, eye problems (rare), headache, loss of appetite, nausea or vomiting, stomach cramps or pain. Doctor monitoring is important, particularly if you have an allergy to any antimalarial drug or a retinal abnormality.
Gold sodium thiomalate (Gold)
Gold sodium thiomalatewas one of the first DMARDs used to treat rheumatoid arthritis. Possible side effects include redness or soreness of tongue; swelling or bleeding gums; skin rash or itching; ulcers or sores on lips, mouth, or throat; irritation on tongue. Joint pain may occur for one or two days after injection. Before taking this drug, tell your doctor if you have any of the following: lupus, skin rash, kidney disease, or colitis. Periodic urine and blood tests are needed to check for side effects.
Leflunomide (Arava®)
Leflunomide reduces signs and symptoms and slows structural damage to joints caused by arthritis. Possible side effects include bloody or cloudy urine; chest congestion; cough; diarrhea; difficult, burning, or painful urination or breathing; fever; hair loss; headache; heartburn; loss of appetite; nausea and/or vomiting; skin rash; stomach pain; sneezing; and sore throat. Before taking this medication, let your doctor know if you have one of the following: active infection, liver disease, known immune deficiency, renal insufficiency, or underlying malignancy. You will need regular blood tests, including liver function tests. Leflunomide must not be taken during pregnancy because it may cause birth defects in humans.
Methotrexate
Methotrexate can be taken by mouth or by injection and results in rapid improvement (it usually takes 3-6 weeks to begin working). It appears to be very effective, especially in combination with infliximab or etanercept. In general, it produces more favorable long-term responses compared with other DMARDs such as sulfasalazine, gold sodium thiomalate, and hydroxychloroquine. Side effects may include abdominal discomfort, chest pain, chills, nausea, mouth sores, painful urination, sore throat, unusual tiredness or weakness. Doctor monitoring is important, particularly if you have an abnormal blood count, liver or lung disease, alcoholism, immune-system deficiency, or active infection. Methotrexate must not be taken during pregnancy because it may cause birth defects in humans.
Sulfasalazine
Sulfasalazineworks to reduce the signs and symptoms of rheumatoid arthritis by suppressing the immune system. Possible side effects include abdominal pain, aching joints, diarrhea, headache, sensitivity to sunlight, loss of appetite, nausea or vomiting, skin rash. Doctor monitoring is important, particularly if you are allergic to sulfa drugs or aspirin, or if you have a kidney, liver, or blood disease.
Source: Vivacare
Last updated : 6/30/2020