Disease-modifying antirheumatic drugs stop or slow the disease process in inflammatory forms of arthritis.
Each DMARD works differently. Conventional DMARDs restrict your immune system broadly. Targeted DMARDs block precise pathways inside immune cells. Biologic DMARDs are produced by living cells and work on individual immune proteins called cytokines.
DMARD Combination Therapies
DMARD Combination Therapies
DMARD Plus a Biologic
DMARDs and Anti-inflammatories
Several DMARDs can damage the fetus but others are safe during pregnancy. Discuss your family plans with your doctor before taking any medication.
Each DMARD has different specific benefits and risks. Be sure to talk over any concerns with your doctor.
The list below contains both conventional and targeted DMARDs.
Benefits and Risks
Risks: Nausea and diarrhea are common side effects. It has been associated with new or worsening depression, suicidal thoughts and other mood changes. Tell your doctor if you have unexplained weight loss.
Risks: The most common side effects of azathioprine are nausea, vomiting and diarrhea. Liver and pancreas damage are less common, but can occur.
Risks: Serious infections, cancers, and blood clots have happened in people taking this drug.
Risks: Cyclophosphamide can have serious side effects, including reduced blood cell counts, fertility problems, birth defects, bladder trouble and heightened cancer risk. If you take this medicine, you will have to be carefully monitored by your doctor.
Risks: Cyclosporine use requires frequent laboratory testing and has many drug interactions. The most common and serious side effects are high blood pressure and kidney problems.
Risks: Hydroxychloroquine has few side effects, but nausea and diarrhea may occur when you first start taking the drug. In very rare cases, vision loss has happened. You will have to see an eye doctor once a year for screening.
Risks: This drug most commonly causes nausea and diarrhea. It can also cause hair loss. It clears from the body slowly; a wash-out procedure may be needed before trying to get pregnant.
Risks: Methotrexate most commonly causes nausea. Other common side effects include swollen gums, mouth sores and excess tiredness. Women who want to become pregnant should not take methotrexate. Methotrexate can cause an increase in liver enzymes and is therefore not recommended for those who drink alcohol.
Risks: Some of the most common side effects of mycophenolate mofetil are nausea and diarrhea. Taking antacids may decrease its effectiveness. Women of childbearing age should use an effective form of birth control at least four weeks before, during and six weeks after treatment.
Risks: Sulfasalazine may cause nausea and vomiting. It can cause yellow-orange urine or skin. It is generally safe for pregnancy, but should not be taken while breastfeeding. This drug may lower sperm count in men, an effect that gets better once the drug is stopped.
Risks: Your cholesterol levels will need to be monitored. The most common side effects are upper respiratory tract infections, diarrhea, headache, nasal congestion, sore throat and runny nose. This drug should also not be used if you have liver problems.
To spot the most serious side effects, your doctors will monitor you with regular lab tests.
Most important, you need to inform your doctor immediately if you experience any side effect, especially nausea, vomiting, fever, rash, or symptoms of infection. Call your doctor if you think you’re pregnant or if you’re planning on becoming pregnant.
Side Effects and Solutions
Injection Site Reactions
For most people, the benefit of taking an approved drug outweighs its possible side effects.
Although side effects can develop within the first six to nine months of treatment, the risk declines with continued use, especially if the drug is improving your condition.
Injection Site Reactions
Injection site reactions are fairly common, especially at the beginning of your treatment. Injection site reactions include
Most reactions clear up without treatment, but you can use a cold compress, topical corticosteroids, oral antihistamines or acetaminophen to ease discomfort. If symptoms persist past 5 days or get worse, call your doctor. You should also change the spot where you inject yourself each time.
If your biologic is given as an infusion, the clinic or facility will begin by getting your vital signs – temperature, blood pressure and pulse. A health professional will continue to monitor you during and after the infusion until you leave the facility.
Before your scheduled biologic infusion, you may receive “pre-meds,” such as an antihistamine, antiemetic (for nausea) or an anti-inflammatory drug (NSAID). These will prevent any mild reactions, such as
Redness at infusion site.
If any of the following more serious reactions occur, the infusion can be stopped and the reaction will be treated on site:
Chest pain or tightness.
High or low blood pressure.
Swelling of face and hands.
Because biologic therapies suppress the immune system, treatment leaves you more prone to infection. The most common are colds, upper respiratory tract infection, sinus infection, sore throat, bronchitis or urinary tract infections.
Tips for avoiding infections:
Wash hand frequently.
Avoid crowded areas, enclosed spaces, public transportation and childcare facilities.
Tell friends and family not to visit if they are sick.
Talk to your doctor before scheduling vaccinations, dental appointments or manicures.
Do not share cups, utensils or personal items.
Do not swim in lakes, rivers, ponds or public pools. Avoid hot tubs.
Ask your doctor about contact with your pets. It’s probably a good idea not to change cat litter or to clean up after the dog. Birds, fish, rodents, reptiles and farm animals should be avoided.
Check with your doctor about whether it’s safe to work in the garden with soil or mulch.
Avoid unpasteurized food, raw eggs or fish, soft cheeses and shellfish.
There are a number of non-drug remedies you can try to combat queasiness.
Place a cold compress on your forehead.
Lie down in a dark, quiet room.
Avoid heat, humidity and stuffy rooms.
Breathe fresh air deeply through your nose; sometimes inhaling peppermint or drinking ginger tea helps.
Suck on ice or sip cool water. Nibble on a saltine cracker if you think your stomach can handle it. Avoid sugary drinks or snacks.
Recognize New Symptoms
A key piece of advice is to listen to your body. The following symptoms are signs of an infection or a more serious condition and you should contact your doctor right away:
Fever, sweat or chills.
Muscle aches, weakness/numbness or tingling.
Shortness of breath or chest pain.
Rash or painful sores; warm, red or painful skin.
Diarrhea or stomach pain.
Burning during urination or urinating more than normal.
Vision problems or dizziness.
Poor appetite or weight loss.
Bleeding or bruising easily.
Before you start taking a DMARD, your doctor will take a baseline x-ray and blood tests. Your disease and any potential drug side effects will be monitored over time. Some of the medications can cause liver damage so you’ll need to let your doctor know if you drink alcohol regularly. You’ll also need to discuss vaccinations and any pregnancy plans with your doctor before staring on DMARDs.
Safety topics for you to discuss with your doctor include:
Preexisting Medical Conditions
Other Medicines You Take
How to Take the Medicine
Some medicines can cause stomach upset if taken on an empty stomach. Others work best on an empty stomach. So be sure to take the medicine as directed.
Food and Supplements
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