Disease-modifying Anti-rheumatic Drugs (DMARDs)

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If a patient has persistent inflammation in several joints for longer than six weeks then the doctor might prescribe a medication called a Disease Modifying anti-rheumatic Drug or DMARD (pronounced DeeMard). They are usually prescribed in addition to anti-inflammatory NSAIDs as the NSAID is designed to reduce the day-to-day inflammation and the DMARD slows down the biological processes that cause the persistent inflammation.

The choice of a specific DMARD will depend upon the type of inflammatory arthritis. Sometimes finding the appropriate maintenance dosage can be a matter of trial and error so the response may not be rapid. DMARDs are a diverse class of medications that approach the task of controlling persistent inflammation through different pathways, but each has been proven effective in its own way. The most commonly prescribed are:

As much of the damage to joints caused by the persistent inflammation of psoriatic arthritis tends to occur in the first two to three years, clinicians are prescribing DMARDs much earlier than in the past, because the benefits of controlling damaging inflammation far outweigh the risks of reversible side effects. These medications are routinely monitored by your doctor in order to minimise the risks of the side effects.

These medications can take up to several months before you begin to feel sustained benefits. Speed of onset of relief isn’t the main driver of these medications. Rather, it's the medication's ability to control your symptoms, and your ability to tolerate the medication over a long period of time that is important. The goal is to use the least amount of drug necessary to keep your inflammatory arthritis under control.

DMARDs come as tablets, capsules and, in some cases, injections; doses can range from once or twice daily to once a week. As mentioned earlier, your doctor will likely have to adjust your medication from time to time, depending on the results of regular monitoring.

Side Effects

The greater benefits offered by DMARDs carry an increased risk of side effects. The vast majority of side effects are rare, and virtually all are reversible by adjusting the daily dose or switching DMARDs. Still, some side effects are common, such as flu-like symptoms, mouth sores, diarrhoea & nausea.

Current available DMARDs