DMARDs can "fundamentally change the process of how the disease attacks the body," says Eric L. Matteson, MD, chair of rheumatology at the Mayo Clinic, in Rochester, Minn.
There are a variety of DMARDS and they can be divided into two groups: older, conventional synthetic drugs or the newer biologics, which are genetically engineered versions of antibodies or proteins that can neutralize harmful inflammation in the body. There are pros and cons to each drug, and one that works well may eventually stop working, and you may need to switch.
Or, the side effects of one drug may prompt a switch to another.
Prescribing the right medication for a patient can be a trial-and-error process, but "in principle every patient should be on a DMARD because that’s the best chance of getting the disease under control," says Dr. Matteson.
Here is a selection of DMARDs you may encounter during treatment for RA.
Brand name: Orencia
How you take it: Intravenous infusion (administered into a vein using an intravenous, or IV, drip), with the second and third doses administered each two weeks after the last, then once a month.
What you need to know: Abatacept, approved at the end of 2005, is one of the newer biologics. It contains a synthetic protein that interferes with the immune system cells, known as T cells. By reducing the activity of these T cells, abatacept lessens inflammation and joint damage. "It interferes with the way cells talk to each other," Dr. Matteson explains. The drug usually starts to work within three months.
Possible side effects: During the infusion: headaches, chills, light-headedness, nausea, shortness of breath. After the infusion: headache, upper respiratory infection, sore throat, nausea.
Brand name: Humira
How you take it: Self-administered subcutaneous (under the skin) injection every other week. Dose and frequency can be increased to every week if the initial response is inadequate.
What you need to know: Adalimumab is one of five tumor necrosis factor (TNF) inhibitors approved by the FDA to treat rheumatoid arthritis. TNF is a type of cell-signaling molecule known as a cytokine which is "important in inflammation," Dr. Matteson explains. It causes damage by attracting immune cells to the area of the joints. This drug works well and relatively quickly but should not be used in patients who have multiple sclerosis, Dr. Matteson says.
Possible side effects: Localized allergic reaction to the shot, fever, chills, chest pain, shortness of breath, itching, headache, nausea, flushing in the face, rash, fatigue, dizziness. TNF blockers can increase the risk of serious infections, cancers such as lymphoma, blood and nervous system disorders, and liver injury.
Brand name: Kineret
How you take it: Self-administered subcutaneous injection usually once a day.
What you need to know: This is the only rheumatoid arthritis drug that works by inhibiting the cytokine known as interleukin (IL-1). Like TNF, IL-1 wreaks havoc by promoting inflammation in the joint, and it may play an important role in joint destruction. Anakinra usually starts working in two to four weeks.
Possible side effects: Allergic reaction at the injection site that usually goes away after one to two months, nausea, diarrhea, headache, infections, lower neutrophil (white blood cell) counts.