Video Q & A:

DMARDs

Question:

What are the most commonly used "traditional" DMARDS?

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

DMARDs come in all shapes and sizes, but you'll find it most helpful to learn about the most common ones. Take a look at this video to get the basics on them.

Transcript: DMARDs, or disease-modifying anti-rheumatic drugs, are the ONLY medications that actually SLOW the progression of rheumatoid arthritis. They prevent joint damage and alleviate your symptoms. Since rheumatoid arthritis occurs when your immune system mistakenly attacks healthy joint lining, DMARDs work to SUPPRESS that over-reaction and hyperactivity. Biologic DMARDs do this on a molecular level, while traditional DMARDs use different mechanisms to impact the cells and proteins INTEGRAL to your immune system. Methotrexate is usually prescribed before other DMARDs. It’s one of the most EFFECTIVE RA medications, but it was FIRST developed to treat cancer. In 1988, the Food & Drug Administration APPROVED it to treat rheumatoid arthritis. It’s usually prescribed in pill form. The patient will start to feel the effects within 3 to 6 weeks, with full benefits HOPEFULLY arriving at around the 3-month mark. The side effects of methotrexate are relatively minimal. Nausea, diarrhea, chest pain, chills, nausea and fatigue are common, while the most serious complications such as liver damage and lung disease are quite rare. And, methotrexate, like ALL DMARDs, can make you more susceptible to infection because it tamps down your immune system. Rheumatologists agree that its benefits outweigh its risk, but your doctor will alert you to any complications that might arise based on YOUR specific medical history. Three other common traditional DMARDs are leflunomide, hydroxychloroquine and sulfasalazine. In order to treat rheumatoid arthritis more effectively, doctors SOMETIMES prescribe one or two of these ALONGSIDE methotrexate. Leflunomide, was approved by the FDA in 1998. It is prescribed if initial treatment isn’t helping. Its benefits—and side effects—are similar to those of methotrexate. But it takes LONGER to start working—4 to 8 weeks for the first signs of improvement. Hydroxychloroquine is a DMARD initially created to treat MALARIA. Approved by the FDA for rheumatoid arthritis treatment way back in 1956, it’s since been surpassed in effectiveness by other RA medications. But it still works – within 1 to 2 months -- for mild rheumatoid arthritis symptoms, or when used in combination with other DMARDs. Its mild side effects include nausea, diarrhea and loss of appetite, while anemia, skin pigment changes, and loss of vision are RARE complications. SULFASALAZINE was developed as an RA treatment in the 1930s, and has regained popularity in recent years. It treats mild to moderate symptoms, and relieves SEVERE symptoms when combined with other DMARDs. You’ll have to be on this drug 1 to 3 months to feel relief from symptoms. Sulfasalazine comes with a few minor side effects, such as nausea and abdominal discomfort. Less commonly, you may experience stomach ulcers or skin rashes. If you want to learn more about any of these medications, talk with your doctor. He or she will tell you about other precautions and interactions you’ll need to know about. More »

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