DMARDs 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 medications that stimulate or restore the ability of the immune system to ﬁght arthritis. 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).Research ﬁndings on anti-TNFs are very promising, they have been used for more than 15 years. 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). 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. E.G. Live vaccines shouldn’t be taken by people receiving certain medications e.g biologics.