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Disease-modifying anti-rheumatic drugs (DMARDs)

DMARDs are used to treat many types of inflammatory arthritis. These medications are used to treat the underlying disease and can help to prevent long-term damage. Early and consistent use is necessary for best results.

Research has clearly shown that in addition to controlling symptoms, DMARDs make a long-term difference in preventing or minimizing the joint damage that can cause devastating disability. Research has shown that there is a short "window of opportunity" at the beginning of the disease process when these medications work best to slow or halt the inflammatory process. For this reason, treatment should begin as early as possible after diagnosis, ideally within the first 3 months after the disease starts. It may take 3 - 12 months for these medications to provide full benefit.

DMARDs are often used together with other types of medications, like NSAIDs and, frequently, biologic response modifiers.

Medications included in this category:
hydroxychloroquine (Plaquenil®)

Administered:
  • pill form
Risks:
Most common:
  • eye toxicity
  • headache
  • weakness
  • hair loss
Most serious:
  • very rare retinal (eye) toxicity in 1 in 50,000 (more common for patients on higher doses)
  • low blood counts
  • rare nerve/muscle dysfunction


sulfasalazine (Azulfidine®)

Administered:
  • pill form
Note:
  • people who are allergic to sulfa must not take this medication
Risks:
Most common:
  • nausea
  • vomiting
  • loss of appetite
  • allergic reactions
  • sore throat
  • rash
  • fever
  • body aches
Most serious:
  • liver toxicity
  • drop in blood counts
  • temporary drop in sperm count
minocycline (Minocin®)

Administered:
  • pill form
Risks:
Most common:
  • diarrhea
  • drowsiness
  • dizziness
  • loss of appetite
  • nausea
  • sun sensitivity
  • yeast infections
  • less common side effects include: difficulty breathing, unusual bleeding/bruising, brown/yellow urine, and skin rash
Most serious:
  • low blood counts
  • drug-induced systemic lupus
  • liver toxicity
methotrexate (Rheumatrex®)

Administered:
  • pill form or one injection weekly
Risks:
Most common:
  • mouth sores
  • nausea
  • low white blood count
  • headache
  • dizziness
  • must be stopped by both men and women 3 months before, and during, pregnancy
More serious:
  • toxicity of liver and bone marrow
  • rare lung toxicity
leflunomide (Arava®)

Administered:
  • pill form
Risks:
Most common:
  • diarrhea
  • nausea
  • headache
  • rash
  • itching
  • loss or thinning of hair and weight loss
More serious:
  • liver toxicity and necrosis leading to death
  • severe infection
  • low blood counts
  • nerve damage
azathioprine (Imuran®)

Administered:
  • pill form
Risks:
Most common:
  • nausea
  • vomiting
  • loss of appetite
Most serious:
  • liver and pancreas toxicity
  • reduced sperm count
  • low blood counts (bone marrow suppression)
  • mouth ulcers


cyclosporin-A (Neoral®)

Administered:
  • pill form
Risks:
Most common:
  • upset stomach
  • vomiting
  • diarrhea
  • loss of appetite
  • increased hair growth
Most serious:
  • tremors
  • unusual bleeding or bruising
  • decreased urination