Disease-modifying antirheumatic drugs (DMARDs)
What are Disease-modifying antirheumatic drugs (DMARDs)
Medications that alter the IMMUNE RESPONSE slow or stop the progression of certain degenerative, AUTOIMMUNE DISORDERS. The most common use of DMARDs is to treat RHEUMATOID ARTHRITIS. DMARDs provide relief from symptoms such as INFLAMMATION and PAIN, and in many people also reduce the JOINT deformities associated with rheumatoid arthritis and other degenerative conditions that result from the same disease process (such as ANKYLOSING SPONDYLITIS).
| DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARDS) | |
|---|---|
| anti-TUMOR NECROSIS FACTORS (TNFS) | azathioprine |
| chloroquine | cyclophosphamide |
| cyclosporine | etanercept |
| gold salts | hydroxychloroquine |
| infliximab | leflunomide |
| methotrexate | penicillamine |
| sulfasalazine | |
How These Medications Work
DMARDs work by altering or suppressing the immune response. Some of the DMARDs are immunosuppressive CHEMOTHERAPY drugs (such as methotrexate and cyclosporine), though researchers do not fully understand how they work to reduce autoimmune inflammation. Other DMARDs are antimalarial medications that suppress immune function by blocking the action of enzymes involved in the inflammatory process. Anti-TNFs are MONOCLONAL ANTIBODIES (MABS) that block the release of TUMOR NECROSIS FACTORS (TNFs), CYTOKINES that influence inflammation during the immune response.
Therapeutic Applications
Because DMARDs can have significant and serious side effects, doctors prescribe them when other therapies are no longer effective. The most common use of DMARDs is to treat rheumatoid arthritis. Doctors also may prescribe DMARDs to treat another degenerative autoimmune arthritis, ankylosing spondylitis, and sometimes to treat other autoimmune conditions such as MYASTHENIA GRAVIS and SYSTEMIC LUPUS ERYTHEMATOSUS (SLE).
Risks and Side Effects
DMARDs can have significant and harmful side effects including DIARRHEA, RASH, ANEMIA, LEUKOPENIA, and increased risk for INFECTION, particularly OPPORTUNISTIC INFECTION, as a consequence of immunosuppression. Methotrexate can cause irreversible CIRRHOSIS and lung damage. A rare and potentially fatal adverse reaction to methotrexate is TOXIC EPIDERMAL NECROLYSIS (also called Stevens-Johnson syndrome). Chloroquine and hydroxychloroquine can cause vision disturbances and RETINOPATHY (permanent damage to the RETINA, resulting in VISION IMPAIRMENT).
DMARDs may also interfere with the actions of other medications. It is important to check with the doctor before using any additional medications, incuding over-the-counter products. Because of the potential risks these side effects have, doctors prescribe most non-MAb DMARDs for people whose conditions are not responding to other treatments.
See also CORTICOSTEROID MEDICATIONS; NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS).
