DMARDs act by altering the disease itself, not just treating your symptoms. They're not painkillers, but they'll reduce pain, swelling and stiffness over a period of weeks or months by slowing down the disease and its effects on your joints.
There are two types of DMARD – conventional DMARDs and biological therapies.
Conventional DMARDs for rheumatoid arthritis
Conventional DMARDs include:
Azathioprine is a conventional DMARD which is very rarely used to treat severe rheumatoid arthritis.
Because these drugs are slow-acting and it may be several weeks before you notice any benefit – so it's important to keep taking them even if they don't seem to be having an effect.
Many of these drugs can be used in combination with each other, which increases the effectiveness. Methotrexate and sulfaslazine is a common combination, but your doctor may suggest others.
Biological therapies for rheumatoid arthritis
Biological therapies (or biologics) are newer drugs which target individual molecules involved in the processes of inflammation and joint damage. Several of them (anti-TNF drugs) target a protein called tumour necrosis factor – for example:
Other biological therapies target different proteins:
Biological therapies tend to work a little more quickly than conventional DMARDs, though it may still be several weeks or months before you get the full benefit from them.
You'll only be given biological therapies if conventional DMARDs haven't worked well enough or if you've had side-effects from them. They're usually given in combination with a conventional DMARD such as methotrexate, though biological therapies are sometimes given on their own if conventional DMARDs aren't suitable for you.
What are the possible side-effects of DMARDs?
The side-effects of DMARDs include:
- nausea or stomach upsets
- skin rashes
When taking any of the biological therapies, you may also experience some of the following:
- sore throat
- unexplained bruises, bleeding or paleness
- symptoms of infection.
A number of DMARDs affect the immune system so you'll be more likely to pick up infections. You should take extra care with food preparation and try to avoid close contact with people with active infections such as chickenpox or shingles. Your doctor may recommend vaccination against flu and pneumonia. However, you should seek advice from your rheumatology team before having live vaccines such as rubella (German measles), yellow fever or shingles vaccines.
DMARDs can sometimes affect the blood or the liver, and because of this you'll need regular medical supervision when you're taking them. This may include regular blood and/or urine tests, which are important for your safety. However, with careful supervision, these drugs are well-tolerated and very effective.