DMARDs Overview

Understand these treatments for inflammatory arthritis.


People with inflammatory arthritis are living full active lives thanks to disease-modifying antirheumatic drugs, or DMARDs. If you’ve been diagnosed with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, juvenile idiopathic arthritis or lupus, you will likely end up taking at least one of the DMARDs. These conditions can’t be cured, but a combination of medications and self-help therapies can help you achieve remission and protect your joints. 

DMARDs help preserve joints by blocking inflammation. Without DMARDs, inflammation would slowly destroy joint tissue over the years to the point where the joint would become misshapen and unusable.

When you’re first diagnosed with inflammatory arthritis, the drug or drug combination you and your doctor choose will depend on many factors, including whether or not you already have joint or organ damage, and if so, how much.

Each DMARD works differently. Traditional DMARDs restrict your immune system broadly. Targeted DMARDs block precise pathways inside immune cells. The biologic drugs are produced by living cells and work on individual immune proteins called cytokines. Biologics are potent and can be expensive, so your doctor may not start you on them right away.

Your doctor will take a baseline x-ray and blood tests before starting you on any of the DMARDs so your disease and any potential drug side effects can 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. Some types of vaccinations may not be safe if you are on DMARDs, and some DMARDs are not recommended if you are pregnant or trying to become pregnant.

DMARDs are not pain medication. They will eventually help your pain because the inflammation and joint tenderness will lessen, but a couple of months may pass before their anti-inflammatory benefits kick in. In the meantime, your doctor may prescribe an NSAID or perhaps a corticosteroid to help with pain and inflammation.

Tell your doctor if you have any side effects, such as nausea, vomiting or hair loss; if urination is painful; or if you are sick with a fever, chills or a sore throat.

A list and brief description of traditional and targeted DMARDs can be found below, but the four most commonly used are methotrexate, hydroxychloroquine, sulfasalazine and leflunomide.

Most of the drugs listed below are approved for rheumatoid arthritis; some are also approved for ankylosing spondylitis, psoriatic arthritis, juvenile idiopathic arthritis or lupus. Often, these drugs are used in combination, usually with methotrexate as the base. To find out more about how your doctor may decide which DMARD or combination is be best for you, see Understanding Your Arthritis Treatment Plan.

Traditional DMARDs

  • Azathioprine (Azasan, Imuran, generic): Comes in tablet only; used most commonly in lupus. This drug depends on a specific enzyme to work and some people lack enough of this enzyme to make the drug effective. Your doctor will test your levels before prescribing azathioprine.
  • Cyclophosphamide (generic only): Comes in capsule, tablet or infusion. Can be used in lupus in patients who do not respond to traditional therapy or who experience kidney damage.
  • Cyclosporine (Neoral, Gengraf, Sandimmune, generic): Comes in capsule or syrup. This medicine is used sometimes for lupus in people who do not respond to other therapies.
  • Hydroxychloroquine sulfate (Plaquenil, generic): Comes in tablet only. Antimalarial drugs are commonly used to treat rheumatoid arthritis and can help improve the skin lesions of lupus, and can hold off disease recurrence and prevent organ damage.  Serious side effects for antimalarial drugs are rare. 
  • Leflunomide (Arava, generic): Comes as a pill taken once a day. People who cannot tolerate methotrexate may take leflunomide. It can also be taken in combination with methotrexate.
  • Methotrexate (Rheumatrex, Trexall, Otrexup, Rasuvo, generic): This drug is taken once a week and comes in tablet or as a self-injectable. It is for adults with active RA and children with active juvenile idiopathic arthritis with more than one affected joint.
  • Mycophenolate mofetil (CellCept, generic): Comes in tablet, capsule and as a self-injectable. This drug may be used in people whose RA does not respond to other therapies.
  • Sulfasalazine (Azulfidine, Sulfazine, generic): Comes in regular or extended-release tablets. This drug is most commonly used in a triple therapy combination for RA (methotrexate, sulfasalazine, hydroxychloroquine).

Targeted DMARDs

  • Apremilast (Otezla): Comes in tablet only. Approved for use in people with psoriatic arthritis.
  • Tofacitinib (Xeljanz): Comes in immediate or extended-release tablets. Approved for use in people with rheumatoid arthritis