Table of ContentsView AllTable of ContentsWhat Are DMARDs?Most Common cDMARDsMethotrexateHydroxychloroquineSulfasalazineLeflunomideOther OptionsSummaryFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
What Are DMARDs?
Most Common cDMARDs
Methotrexate
Hydroxychloroquine
Sulfasalazine
Leflunomide
Other Options
Summary
Frequently Asked Questions
Rheumatoid arthritis(RA) is the most common form of autoimmune arthritis, affecting millions of people worldwide annually.RA most often affects the joints, but it can also progress and cause damage to organs such as the skin, eyes, heart, lungs, and kidneys. While there is no cure for RA, there are many medications that work to slow or halt the progression of disease.
Verywell / Mayya Agapova
Despite no definitive cure for RA, there is no lack ofoptions for treatment. Currently there are multiple categories of DMARDs on the market. They work to keep RA activity levels at their lowest possible levels within the body. Some DMARDs can even put the disease into remission.
These treatment categories include conventional DMARDs (cDMARDs), biologic DMARDs (bDMARDs), and targeted synthetic DMARDs (tsDMARDs).
While the purpose of all DMARDs is to decrease inflammation, there is not a single means of achieving that goal. Most DMARDs have unique mechanisms and stop inflammation through a variety of ways.
Treatment guidelines consider DMARDs as the primary treatment option for RA.
Tailored TreatmentGiven the complexity and intricacies of rheumatoid arthritis, you should consult with your healthcare provider orrheumatologistto develop the most appropriate treatment plan tailored to you.
Tailored Treatment
Given the complexity and intricacies of rheumatoid arthritis, you should consult with your healthcare provider orrheumatologistto develop the most appropriate treatment plan tailored to you.
Most Commonly Used cDMARDs for RA
The most common cDMARDs used in the treatment of RA include but are not limited to:
Read on for a deeper look into each of these medications, their functions, benefits, and potential side effects.
What You Need to Know About Methotrexate
Methotrexate(MTX) is perhaps the oldest and most commonly used cDMARD on the market. Its brand names include Rasuvo, Otrexup, Trexall, and Rheumatrex.
Originally designed to treat certain types of cancers, at much lower doses it is used to treat other conditions, including the autoimmune diseases RA,psoriatic arthritis, andlupus.
In current RA treatment guidelines, MTX is strongly recommended over other DMARDs for patients with moderate-to-severe RA who have not been on any other DMARDs previously.
What You Need to Know About Hydroxychloroquine
Hydroxychloroquine, sold under the brand name Plaquenil, is an antimalarial medication with anti-inflammatory properties, decreasing the swelling and pain associated with RA. It is FDA-approved for use in the treatment of RA and forms of lupus.
Hydroxychloroquine can be used alone or in combination with other DMARDs.
What You Need to Know About Sulfasalazine
Sulfasalazine, sold under the brand name Azulfidine, can reduce the progression of joint damage. It can be used in combination with methotrexate and hydroxychloroquine, in what is commonly referred to as “triple therapy.”
What You Need to Know About Leflunomide
Leflunomide, sold under the brand name Arava, is used for the treatment of moderate-to-severe RA. In most cases it appears to be as effective as methotrexate.
Additional DMARD Options
In addition toother treatment options, such as nonsteroidal anti-inflammatories (NSAIDs) and corticosteroids, if conventional DMARDs fail to slow disease progression, your healthcare provider may consider initiating a biologic or target-specific DMARD.
Common bDMARDs used in the treatment of RA include but are not limited to:
Newer and common tsDMARDs used in the treatment of RA include but are not limited to:
There are various DMARDs available for treating RA, and some work in combination with others. They have different mechanisms, dosages, and side effects, so be sure to discuss your specific case of RA closely with your healthcare provider to get a treatment plan tailored to you.
A Word From Verywell
If you have rheumatoid arthritis and are currently on or thinking of starting DMARD therapy, be sure to speak with your healthcare provider about which treatment options will work best for you. Do not hesitate to mention if your current treatment is not effective or if you are still experiencing joint problems or other symptoms.
If you or your partner plan to become pregnant, discuss alternative treatment options with your physician, as some DMARDs cannot be taken during pregnancy or conception.
Frequently Asked QuestionsTypically, DMARD therapy is initiated within the first three to six months of disease onset, as it can take several weeks or months before these medications take full effect. Just as each case of RA is different, so is every treatment plan. For that reason, it is crucial to discuss your disease and its severity with your healthcare provider. Your healthcare provider can determine how soon to start you on a DMARD.Your physician’s clinical knowledge coupled with the latest treatment guidelines will determine the best fit for you. For people with moderate-to-severe RA, methotrexate is usually the first-line treatment. For people with low-to-moderate RA, hydroxychloroquine may be initiated first.Depending on which DMARD is started, side effects will vary but can include headache, nausea, gastrointestinal issues, diarrhea, rash, photosensitivity, visual changes, as well as changes in liver and kidney function and red or white blood cell counts.
Typically, DMARD therapy is initiated within the first three to six months of disease onset, as it can take several weeks or months before these medications take full effect. Just as each case of RA is different, so is every treatment plan. For that reason, it is crucial to discuss your disease and its severity with your healthcare provider. Your healthcare provider can determine how soon to start you on a DMARD.
Your physician’s clinical knowledge coupled with the latest treatment guidelines will determine the best fit for you. For people with moderate-to-severe RA, methotrexate is usually the first-line treatment. For people with low-to-moderate RA, hydroxychloroquine may be initiated first.
Depending on which DMARD is started, side effects will vary but can include headache, nausea, gastrointestinal issues, diarrhea, rash, photosensitivity, visual changes, as well as changes in liver and kidney function and red or white blood cell counts.
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American College of Rheumatology.Rheumatoid arthritis.Wasserman A.Rheumatoid arthritis: common questions about diagnosis and management.AFP. 2018;97(7):455-462.Fraenkel L, Bathon JM, England BR, et al.2021 american college of rheumatology guideline for the treatment of rheumatoid arthritis.Arthritis Care Res. 2021;73(7):924-939. doi:10.1002/acr.24596Friedman B, Cronstein B.Methotrexate mechanism in treatment of rheumatoid arthritis.Joint Bone Spine. 2019;86(3):301-307. doi:10.1016/j.jbspin.2018.07.004Johns Hopkins Arthritis Center.Rheumatoid arthritis treatment options.American College of Rheumatology.Hydroxychloroquine(Plaquenil).American College of Rheumatology.Sulfasalazine(Azulfidine).
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American College of Rheumatology.Rheumatoid arthritis.Wasserman A.Rheumatoid arthritis: common questions about diagnosis and management.AFP. 2018;97(7):455-462.Fraenkel L, Bathon JM, England BR, et al.2021 american college of rheumatology guideline for the treatment of rheumatoid arthritis.Arthritis Care Res. 2021;73(7):924-939. doi:10.1002/acr.24596Friedman B, Cronstein B.Methotrexate mechanism in treatment of rheumatoid arthritis.Joint Bone Spine. 2019;86(3):301-307. doi:10.1016/j.jbspin.2018.07.004Johns Hopkins Arthritis Center.Rheumatoid arthritis treatment options.American College of Rheumatology.Hydroxychloroquine(Plaquenil).American College of Rheumatology.Sulfasalazine(Azulfidine).
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American College of Rheumatology.Rheumatoid arthritis.Wasserman A.Rheumatoid arthritis: common questions about diagnosis and management.AFP. 2018;97(7):455-462.Fraenkel L, Bathon JM, England BR, et al.2021 american college of rheumatology guideline for the treatment of rheumatoid arthritis.Arthritis Care Res. 2021;73(7):924-939. doi:10.1002/acr.24596Friedman B, Cronstein B.Methotrexate mechanism in treatment of rheumatoid arthritis.Joint Bone Spine. 2019;86(3):301-307. doi:10.1016/j.jbspin.2018.07.004Johns Hopkins Arthritis Center.Rheumatoid arthritis treatment options.American College of Rheumatology.Hydroxychloroquine(Plaquenil).American College of Rheumatology.Sulfasalazine(Azulfidine).
American College of Rheumatology.Rheumatoid arthritis.
Wasserman A.Rheumatoid arthritis: common questions about diagnosis and management.AFP. 2018;97(7):455-462.
Fraenkel L, Bathon JM, England BR, et al.2021 american college of rheumatology guideline for the treatment of rheumatoid arthritis.Arthritis Care Res. 2021;73(7):924-939. doi:10.1002/acr.24596
Friedman B, Cronstein B.Methotrexate mechanism in treatment of rheumatoid arthritis.Joint Bone Spine. 2019;86(3):301-307. doi:10.1016/j.jbspin.2018.07.004
Johns Hopkins Arthritis Center.Rheumatoid arthritis treatment options.
American College of Rheumatology.Hydroxychloroquine(Plaquenil).
American College of Rheumatology.Sulfasalazine(Azulfidine).
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