DMARDs: Side Effects and Solutions

Here are the most common side effects associated with DMARDs, with tips for lessening their effects.


Taking DMARDs for your inflammatory arthritis will decrease pain and inflammation, prevent joint damage, and slow the progression of your disease over time. They also may bring side effects, some troublesome, others more serious.

To spot the most serious side effects, doctors will monitor you with regular lab tests.

“I think that it’s almost like a marriage,” says Bella Fradlis, MD, assistant professor of medicine in rheumatology at Albert Einstein College of Medicine, and attending physician in rheumatology, Montefiore, in Bronx, New York. “I tell my patients that you’re going to come to see me every so often but you’re always going to come see me.”

Most important, you need to inform your doctor immediately if you experience any side effect, especially nausea, vomiting, fever, rash, if you think you have any kind of illness or infection, or if you think you’re pregnant or if you’re planning on becoming pregnant.

Let’s look at some of the most common side effects of DMARDs, and possible solutions.

Stomach Upset, Nausea, Diarrhea

The most common side effect with DMARDs is stomach upset, especially with methotrexate. Some options and remedies for you to try:

  • Split your methotrexate dose, taking half in the evening, and half in the morning. “Our bodies are not used to those medications,” says Fradlis. Talk to your doctor first before trying this.
  • Ask your doctor about switching to an injectable. For people who suffer great nausea with methotrexate, a weekly self-injectable is an option.
  • Place a cold cloth on your forehead and lie down in a dark room.
  • Suck on ice chips and take small sips of water. Avoid sugary drinks or snacks.
  • Nibble on bland crackers or toast.

Infection Risk

DMARDs work by suppressing your over-active immune system. This can put you at increased risk for a variety of infections. Biologic agents, such as TNF inhibitors, are even more associated with increased risk of infection, explains Fradlis. Here are common-sense tips for avoiding infection:

  • Wash your hands often.
  • Avoid close contact with people who are actively infected (especially with chickenpox or shingles).
  • Stay up-to-date with vaccinations. The annual injected flu and pneumonia vaccines are advised, but your doctor may recommend other vaccines as well.

Hair Loss

Both methotrexate and leflunomide can cause hair loss, but not like chemotherapy where you would lose your entire head of hair, says Dr. Fradlis. Some people experience thinning in the front.

  • Folic acid supplements can protect you from many side effects of methotrexate.
  • Biotin may also protect you from hair loss, but there’s no perfect remedy for hair thinning.


Another common side effect of DMARDs is fatigue. You may feel winded or tired, most commonly with methotrexate.

  • Achy joints can make good sleep a challenge. Set a regular bedtime ritual that works for you, perhaps a warm bath or quiet reading.
  • Getting regular exercise will help reduce fatigue and increase energy levels.
  • Balance the extra activity with restful periods.
  • Eat a nutritious diet that includes protein, grains, fruits and vegetables.

Liver Damage

Some DMARDs can cause liver damage so you’ll need to let your doctor know if you consume alcohol regularly.

  • Make sure to keep your regular appointments for blood tests to monitor for liver problems, even if you’ve gone years without an issue.

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