Disease-modifying anti-rheumatic drugs

Disease-modifying anti-rheumatic drugs (DMARDs) are a group of drugs which have a dampening effect on the over-active immune system, which is responsible for causing inflammation and its resulting symptoms. They may be prescribed individually, or in combination, which can sometimes be more effective. Because these drugs affect the immune system, it is important to report any symptoms of infection to your doctor. If your disease is resitant to DMARDs, you may be considered for biologic therapy. The National Rheumatoid Arthritis Society has a good summary of DMARDs here (in the context of rheumatoid arthritis). Arthritis UK also has a summary of DMARDs available here.

Azathioprine

Azathioprine reduces the activity of the immune system, which in turn reduces inflammation in rheumatological diseases. Inflammation not only causes symptoms such as pain and swelling, but also leads to tissue damage within the body (e.g. joint damage in rheumatoid arthritis), so using a DMARD like azathioprine can prevent further damage. Azathioprine tends to used for diseases such as lupus, rheumatoid arthritis and polymyositis and dermatomyositis. Before prescribing azathioprine you may need a blood test. For more information visit the Arthritis Research UK website.

Ciclosporin

Like azathioprine, ciclosporin also reduces the activity of your immune system, which leads to reduced inflammation and prevents damage to joints and other tissues as a result. Ciclosporin tends to be used for conditions such as psoriatic arthritis and lupus. There are some people who cannot have ciclosporin treatment for health reasons, and your doctor will give you a health check before starting the drug. For more information visit the Arthritis Research UK website.

Cyclophosphamide

Cyclophosphamide supresses your immune system by targeting rapidly multiplying cells. It is used to treat diseases such as lupus, vasculitis and myositis, and occasionally severe cases of rheumatoid arthritis. You will need a blood and urine test before starting cyclophosphamide and will have regular health checks once you are on the drug. For more information visit the Arthritis Research UK website.

Gold injections

Gold injections work by reducing the activity of your immune system. They are given as an intramuscular injection into the buttock, normally once a week initially, although the frequency may be reduced later on in the treatment. Gold is normally used for rheumatoid arthritis, although it can be used for other conditions such as psoriatic arthritis. For more information visit the Arthritis Research UK website.

Hydroxychloroquine

Hydroxychloroquine is another DMARD that acts on the immune system to reduce inflammation, and the subsequent damage on tissues that the inflammation inflicts. It is most often used for conditions like rheumatoid arthritis and lupus. Hydroxychloroquine is often taken in combination with other drugs such as methotrexate. Before starting treatment, you may need a blood test, and once you are on hydroxychloroquine you will need to have your eyes checked regularly. For more information visit the Arthritis Research UK website.

Leflunomide

Like the other DMARDs, leflunomide dampens down the immune system leading to a reduction in the inflammation which characterises rheumatological conditions. As a result, it can reduce the symptoms of pain, stiffness and swelling. It is usually used to treat rheumatoid arthritis as well as other auto-immune diseases. Before taking this drug you may need to have a blood test as well as a general health check. For more information visit the Arthritis Research UK website.

Methotrexate

Methotrexate is a commonly-used DMARD which, like the others, reduces the activity of the immune system, resulting in a decrease in the inflammation which drives rheumatological conditions. This helps to prevent underlying joint damage caused by on-going inflammation, as well as easing the symptoms of pain and swelling associated with these conditions. Methotrexate is usually prescribed for people with rheumatoid arthritis, psoriatic arthritis, juvenile idiopathic arthritis and vasculitis. It is usually taken once a week in tablet form, although injections are also available. You will need a blood test and a chest X-ray before starting the drug, and the blood tests will continue at regular intervals when taking methotrexate. For more information visit the Arthritis Research UK website.

Mycophenolate

This DMARD works, like the others, by dampening down the immune system and reducing inflammation. It is usually used to treat conditions like lupus, scleroderma and vasculitis. Before starting this drug, you will usually have a blood test, and will have further blood tests at regular intervals whilst taking it. For more information visit the Arthritis Research UK website.

Sulfasalazine

Sulfasalazine is a DMARD which works to reduce inflammation by dampening down the body’s immune system. It is usually prescribed for conditions such as rheumatoid arthritis, psoriatic arthritis and arthritis associated with inflammatory bowel disease. Once on the drug, you will need to have regular blood tests. You may notice that sulfasalazine stains your urine orange – this is nothing to worry about. For more information visit the Arthritis Research UK website.

Last updated: October 3, 2017