What are DMARDs?

What you should know

What are DMARDs?

Disease-modifying anti-rheumatic drugs (DMARDs) belong to the second group of drugs and are used to treat inflammatory arthritis such as rheumatoid arthritis, psoriatic arthritis, juvenile arthritis and ankylosing spondylitis. Most DMARDs act by regulating the immune system. They are not specific painkillers, but they lessen the activity of arthritis by reducing swelling and stiffness - thereby reducing the pain.

Disease-modifying drugs

• are slow acting, so it can take weeks or even months for their full effect to be felt;
• reduce pain, swelling and stiffness;
• are often effective where NSAIDs alone are not;
• are often used alongside another drugs , this is called combination therapy;

Specific DMARD drugs include: hydroxychloroquine, leflunomide and sulfasalazine.

Other types of DMARDs include:

• Immunosuppressants – reduce the activity of the immune system – the body’s natural defence – because in some forms of arthritis, like rheumatoid arthritis, the immune system causes the body to attack its own tissues. Immunosuppressant drugs include azathioprine, cyclosporin, cyclophosphamide and methotrexate.
• Biologic response modifiers – also known as biologics, are targeted medications that modify the abnormal response of the immune system that cause arthritis. .
• JAK inhibitors –  work by blocking the action of enzymes called Janus kinases. These enzymes are involved in setting up processes that lead to inflammation, and blocking their effect brings inflammation in the joints under control.

This group of drugs includes anti-TNFs – which work by blocking the action of a chemical called tumour necrosis factor (TNF). TNF is thought to play an important role in driving the inflammation and tissue damage of rheumatoid arthritis, and anti-TNFs may be able to delay or even prevent this damage.

Specific anti-TNFs include etanercept (Enbrel), infliximab (Remicade),certolizumab (Cimzia), golimbumab ( Simponi) and adalimumab (Humira). Though they are not free of side effects and aren’t suitable for everyone, however for people with moderate to  severe rheumatoid arthritis who have not been helped by older disease-modifying drug, anti –TNF drugs can be very effective.

They can be used by themselves or taken in conjunction with methotrexate or another DMARD such as leflunomide which is a form of combination therapy. Anti –TNF’s can begin to make a change from one to twelve weeks. While these drugs will reduce symptoms and decrease further joint damage, they will not cure the disease.

Other biologic treatments for rheumatoid arthritis have become available since anti-TNFs were developed. They target different parts of the immune system thought to play a part in inflammatory arthritis. These include rituximab (MabThera), abatacept (Orencia),tocilizumab (RoActemra) and ustekinumab (Stelara).

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What you should know

Because these drugs affect your immune system, you may be more susceptible to infection and other side effects. So if you develop a sore throat or other new symptoms, you should tell your doctor or nurse immediately. People on DMARD treatment should have their blood count and liver enzymes checked regularly.

The HSE recommends that all people taking immunosuppressants and steroid tablets should have yearly flu vaccinations and pneumonia vaccinations every 5 years. Some other vaccinations can be dangerous, so it is very important to discuss immunisation with your GP before starting any immunosuppressant  medication. Live vaccines shouldn’t be taken by people receiving certain medications e.g biologics.

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Page updated 11 May 2021