This type of medicine is the mainstay of RA treatment.
When your rheumatoid arthritis (RA) is acting up, you do your best to feel better by avoiding RA flare triggers and making RA-friendly lifestyle changes. While self-management and care is important, it’s also important to get your RA treated by a medical professional. The longer RA goes untreated, the more damage occurs to the joints.
Recent treatment options have allowed doctors and patients to control RA better and significantly slow the progression of the disease. One group of medications used to treat rheumatoid arthritis is called DMARDs.
What Are DMARDs?
DMARD stands for disease-modifying antirheumatic drugs. As the name suggests, DMARDs work to modify the course of the disease and are the mainstay of treatment for RA. Think of it this way: RA has a plan of how it’s going to affect your body over time, but DMARDs are going to disrupt that plan.
“Unlike nonsteroidal [anti-inflammatory drugs] (NSAIDs) … which just control the pain, what DMARDs do is they control inflammation,” says Saakshi Khattri, MD, a rheumatologist and assistant professor at the Department of Rheumatology, Icahn School of Medicine at Mount Sinai Hospital in New York City. “The idea is, with these medications on board, the disease process is aborted and patients don’t progress.”
Types of DMARDs include:
Conventional DMARDs can be used alone or in combination with other DMARDs to control inflammation.
Biologics target immune system cells, joint molecules, and products secreted in the joints that cause inflammation and destroy joints. Different kinds of biologics target specific types of molecules. Learn more about how bioloigics treat RA here.
JAK inhibitors target and inhibit the Janus kinase, which contributes to inflammation. Learn more about JAK inhibitors for RA here.
Which DMARD Is Right for You?
“How we decide what to treat a patient with really comes down to how active the disease is,” says Dr. Khattri. In choosing a treatment, doctors will look at:
Erosion of cartilage and/or bone in the patient’s joints, and narrowing of the joint space
How significantly the disease is impacting the patient’s quality of life
Whether or not the patient has other health conditions
“In general, it’s not a one-size-fits-all story here. We have so many DMARDs to choose from which block different pathways of the immune system, that if one doesn’t work I’m sure something else will,” says Dr. Khattri.
Saakshi Khattri, MD, is a rheumatologist and assistant professor at the Department of Rheumatology, Icahn School of Medicine at Mount Sinai Hospital in New York City.
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DMARDs basically are an abbreviation for something
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which is called disease-modifying antirheumatic drugs.
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So unlike nonsteroidal pain medications that exist over-the-counter
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that can be given prescription, which just control the pain,
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what DMARDs do is they control inflammation,
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and the idea is that with these medications on board,
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the disease process is aborted, and that patients don't progress.
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When we have a patient with rheumatoid arthritis,
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to decide on what treatment to start, it's a long process.
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DMARDs are of several types.
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The first type is the conventional DMARDs
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that have been around for many, many years,
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and they can be used in various permutations and combinations.
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The second category are the biologic DMARDs,
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and they actually fall into many subcategories,
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depending on the molecule that's being blocked.
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We have the IL-1 receptor blockers.
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Then we have the IL-6 receptor blockers.
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There's something called TNF blockers, which block a molecule
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called TNF, which is a pro-inflammatory molecule.
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Then there's something called the T-cell costimulation blocker,
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which basically blocks the T-cells from being activated.
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The last subcategory within the biologic category
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is the B-cell blocker, and what they basically do is block
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the B-cells from producing pathogenic antibodies,
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something called the rheumatoid factor, or the CCP antibody,
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which are thought to be pathogenic for rheumatoid arthritis.
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And finally we have another subset of DMARDs,
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and those are the newer ones, the janus kinase inhibitors,
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and they can be used as well.
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How we decide what to treat a patient with really comes down
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to how active their disease is, or are there lots of erosions
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on X-rays, how significantly is the quality of life impaired?
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What other comorbid conditions a patient has,
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which might preclude a certain treatment versus another.
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So in general, it's not a one-size-fits-all story here.
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We have so many DMARDs to choose from,
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which block different pathways of the immune system,
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that if one doesn't work, then I'm sure something else will.
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Rheumatoid Arthritis Treatment (Beyond the Basics). UpToDate. (Accessed on January 23, 2020 at https://www.uptodate.com/contents/rheumatoid-arthritis-treatment-beyond-the-basics)Disease-Modifying Antirheumatic Drugs (Beyond the Basics). UpToDate. (Accessed on January 23, 2020 at https://www.uptodate.com/contents/disease-modifying-antirheumatic-drugs-dmards-beyond-the-basics)