A Beginner's Guide to RA: DMARDs

Patient Expert

This is the second post in a series on rheumatoid arthritis (RA) medications: what they are, why we take them, and how to manage common side effects. The first post was about NSAIDs, which treat symptoms of inflammation and pain. Today, I'll tell you about DMARDs, medications to treat the underlying cause, the disease itself. There are two general classes of medications used to treat RA: non-biologic DMARDs and Biologics. Next week's post it will look at Biologics in more detail.

What are DMARDs?

The word DMARDs is the abbreviation for disease modifying antirheumatic drugs. They do exactly what the name suggests. This type of medication modifies (that is, treats) rheumatic diseases, such as RA and other types of inflammatory arthritis. Instead of merely addressing the symptoms, such as NSAIDs do, DMARDs go to the root of the problem to slow down RA or, ideally, cause remission.

There are several non-biologic DMARDs, many of which have been on the market for years, if not decades. They include methotrexate, leflunomide (Arava), hydroxychloroquine (Plaquenil), sulfasalazine (Azulfidine) and minocycline. Of these, methotrexate is considered the "gold standard." Your first prescription for a DMARD will likely be methotrexate.

Some DMARDs were originally used for other medical conditions and found to work for RA, as well. For instance, Plaquenil is a malaria drug and methotrexate is a chemotherapy medication. It's important to know that when treating RA, methotrexate is used in much smaller doses than when it is used as a chemotherapy agent. It therefore doesn't usually cause the same intense side effects for which chemotherapy is known.

Why Take DMARDs?

RA is a serious chronic illness. There is no cure. Although it is best known for its impact on joints, RA is systemic, meaning that the inflammation may also affect other systems of the body, including tendons, the vascular system, and internal organs. If left untreated, RA will progress, slowly and sometimes not so slowly damaging these systems. Most visibly, it can cause damage and deformity to the joints, leading to disability. The inflammation can also affect the heart, causing people with RA to have a higher risk of heart attack and stroke.

Reading such information is enough to cause even the most stoic among us to hyperventilate. Knowing the facts is important, though it helps you make better decisions about treatment. There is a good reason to take DMARDs for your RA. The goal of treatment is to control your symptoms, stop the progression of the disease, allowing you to participate at work and at home. Increasingly, more and more people achieve remission or low disease activity. Unfortunately, many still struggle to find the right medication for them. More medications are in development, offering hope for the future.

Common Side Effects and How to Manage Them

Looking up the side effects to any medication on the Internet is not conducive to lowering your anxiety levels. Manufacturers are legally obligated to list all side effects experienced during testing and these lists can be long and scary. It's important to know that you are not destined to experience all, or even any, of the side effects. Reactions to medication are different from person to person, both in terms of how effective they are and whether you have any side effects. Some people breeze through with no side effects at all, others (like me) are side effect magnets. For most, the experience is somewhere in between, with side effects usually being manageable.

DMARD medications are quite different, so side effects vary. Side effects to most RA meds, regardless of class, tend to involve unsettled gastrointestinal symptoms, such as feeling queasy and constipation or diarrhea. Another common side effect is fatigue after taking the medication. Several of the DMARDs are taken once a week, so you adapt your medication schedule to when you have some downtime. We have posts in our archives that can help you manage GI side effects, as well as manage fatigue.

DMARDs can also cause more serious side effects, including kidney and liver damage. Your rheumatologist will manage this risk by ordering regular blood work to keep an eye on their function. The good news is that should these indicate that the medication is starting to affect your internal organs, stopping the drug will usually stop and reverse that effect.

What has been your experience taking DMARDs for your RA?

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Lene writes the award-winning blog The Seated View. She's the author ofYour Life with Rheumatoid Arthritis: Tools for Managing Treatment, Side Effects and Pain and 7 Facets: A Meditation on Pain.