Disease-modifying antirheumatic drugs (DMARDs) decrease or stop joint damage caused by rheumatoid arthritis (RA) and other conditions and diseases and can often preserve use of joints. Some DMARDs were developed to treat RA, but others originated as drugs to treat cancer or malaria or to prevent rejection of organ transplants.

DMARDs work by suppressing the body’s immune and/or inflammatory systems to slow down or stop the progression of the condition being treated. However, how exactly this is accomplished is not known. DMARDs are usually taken orally but can also be injected.

Because of the potential for serious side effects, in the past this group of drugs was used as a second option against RA when less potent drugs, such as aspirin or other NSAIDs, had proven ineffective. However, research has shown that people with RA treated earlier with DMARDs tend to have better long-term results, greater mobility and a smaller risk of premature death. As a result, today DMARDs are often prescribed early in the course of the disease.  Research has also shown that the combination of DMARDs started earlier has been beneficial in reducing joint damage, pain and swelling in patients with rheumatoid arthritis.

Treatment for RA usually begins within about three months of the onset of the disease to help prevent joint damage before it begins. DMARDs often help prevent much of this damage while also reducing pain, inflexibility and helping maintain physical mobility. Because their effectiveness may diminish over time, patients may be prescribed several different DMARDs over the course of the disease.

DMARDs are not designed for immediate relief and may not work for everyone. They often take several weeks or months of treatment before the effects are noticeable. Therapy with DMARDs may cause arthritis to go into remission, but the disease often recurs once treatment is stopped. As a result, patients may be encouraged to continue the use of DMARDs even if the progression of RA has ceased. Recent research suggests that patients who respond poorly to a DMARD initially can have better results when retrying the drug later.

Patients are often prescribed DMARDs in combination with other immunosuppressives, such as tumor necrosis factor (TNF) inhibitors or other biologic response modifiers (BRMs). Other medicines, such as NSAIDS, corticosteroids or other analgesics, may be used along with DMARDs to help alleviate symptoms, though DMARDs may make the need for their use less frequent. Combinations of DMARDs may be used over the long term, with adverse effects being no more common than when only one DMARD is used for treatment.