Video Q & A:



How do different kinds of DMARDs treat RA?

Expert:   Linda Russell, MD, Hospital for Special Surgery »

The main similarity between all DMARDs is that they slow the progress of your rheumatoid arthritis. They all do this with different mechanisms. Get the specifics.

Transcript: Disease-modifying anti-rheumatic drugs, or DMARDs, are immune suppressants that actually slow the rheumatoid arthritis process, instead of simply relieving pain. Rheumatoid arthritis means that your overactive immune system is mistakenly targeting the lining of your joints instead of foreign bacteria. DMARDs work to stop this process from happening. There are several types of DMARDs—some block enzymes involved in the immune system process. Others slow the disease by hindering the INTERACTIONS between certain cells. The following DMARDs are some of the most common. Methotrexate, the most commonly prescribed DMARD, inhibits several enzymes that are an essential part of the autoimmune response. That means less immune system over-activity, less inflammation in the joints, less damage and pain. Leflunomide is a DMARD that researchers still don’t quite understand. They do know that its ability to slow down joint damage may be related to its ability to block cell reproduction. Sulfasalazine is also an important DMARD—but again, researchers aren’t sure how it treats RA-- it might be related to folate reduction. Hydroxychloroquine is another effective DMARD. It keeps the lining of your joints from giving destructive immune cells the come hither—and it may make even more far-reaching changes in how the body produces various immune system components that are involved in the attack. Then there are the newest DMARDs on the market—BIOLOGICS. These are made of specific proteins that closely mimic those that naturally occur in our body. On a molecular level, they are able to interrupt the autoimmune attack that triggers RA. One category of biologics targets a substance in the blood called tumor necrosis factor or TNF. People with RA have too much TNF in their blood and TNF inhibitor drugs—for example, etanercept, infliximab and adalimumab--all reduce TNF activity and the inflammation it sparks in your joints. There are 5 approved TNF inhibitors. Another type of BIOLOGIC is abatacept. It is the first T-cell costimulatory blocker. Also a biologic, abatacept works by turning off the over-reaction of some T-cells which play a large role in the autoimmune attack on the lining of your joints. B-cells are another type of immune cell—they create abnormal antibodies in the blood that cause RA symptoms. Rituximab is the only biologic that removes B-cells. Finally, Anakinra blocks the interaction between a protein called IL-beta and cells that would otherwise combine to produce inflammation. Non-biologic DMARDs – usually methotrexate -- are often used together with biologic DMARDs—doctors often prescribe a combination of two or even three. This is becoming more common with RA treatment, and offering patients a greatly improved quality of life. If you’d like to learn more about a specific drug, ask your rheumatologist for more details. More »

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