Disease-modifying antirheumatic drugs (DMARDs) Part 2 - Pharmacology

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WHAT ARE DISEASE-MODIFYING ANTIRHEUMATIC DRUGS ?

DMARDs work to suppress the body's overactive immune and/or inflammatory systems. They take effect over weeks or months and are not designed to provide immediate relief of symptoms.

Other medicines, such as pain relievers, nonsteroidal antiinflammatory drugs (eg, ibuprofen or naproxen), and, sometimes, prednisone, are given to provide faster relief of ongoing symptoms. DMARDs are often used in combination with these medications to reduce the total amount of medication needed and to prevent damage to joints.

DISEASE-MODIFYING ANTIRHEUMATIC DRUGS — The choice of DMARD depends on a number of factors, including the stage and severity of the joint condition, the balance between possible side effects and expected benefits, and patient preference. Before treatment begins, the patient and clinician should discuss the benefits and risks of each type of therapy, including possible side effects and toxicities, dosing schedule, monitoring frequency, and expected results. Certain screening tests, including blood tests for past exposure to certain infections, may be needed before starting some of these medications.

In some cases, one DMARD is used. In others, more than one medication may be recommended. Sometimes a patient must try different medicines or combinations to find one that works best and that has the fewest side effects. A patient who does not respond completely to a single DMARD may be given a combination of DMARDs, such as methotrexate plus another medication.

The most common DMARDs are methotrexate, sulfasalazine, hydroxychloroquine, and leflunomide. Less frequently used medications include gold salts, azathioprine, and cyclosporine.