The most common types of disease-modifying antirheumatic drugs (DMARDs) used to treat pain conditions are:

The most commonly administered DMARDs include:

• Methotrexate (Folex, Rheumatrex, Trexall). Regularly used to treat cancer and psoriasis. Methotrexate is also the most commonly used DMARD for rheumatoid arthritis (RA). It reduces inflammation by obstructing how the body metabolizes folic acid. It can be given orally or injected. Long-term use can damage the liver, making routine tests of liver function necessary. Use of alcohol should be avoided when taking methotrexate. Recent research suggests that use of methotrexate may prevent undifferentiated (generalized) arthritis from escalating to RA.
  
  
• Hydroxychloroquine (Plaquenil). Originally used to treat malaria, hydroxychloroquine is also used for patients with  RA. Taken orally, hydroxychloroquine suppresses the immune system’s reaction to RA that causes pain and inflammation. Eye exams may be given about every six months because visual impairment is a rare side effect of the drug.  Visual impairment usually occurs at higher doses, and the doses used these days are substantially low.
  
  
• Sulfasalazine (Azulfidine). A combination of salicylate and an antibiotic. Sulfasalazine blocks inflammation and restrains bacteria growth and is given in liquid or tablet form. It is most commonly used to treat inflammatory bowel disease, but also for other conditions, such as RA, psoriatic arthritis and ankylosing spondylitis. The most common side effect is nausea and abdominal pain. It can also increase sensitivity to sunlight.
  
  
• Methotrexate (Folex, Rheumatrex). Regularly used for cancer and psoriasis treatment. Methotrexate is also the most commonly used DMARD to treat RA. It reduces inflammation by obstructing how the body metabolizes folic acid. It can be given orally or injected. Long-term use can damage the liver, making routine tests of liver function necessary. Use of alcohol should be avoided when taking methotrexate.  
  
  
• Leflunomide (Arava). The only DMARD specifically developed for the treatment of RA. Given orally, leflunomide may reduce pain and inflammation associated with RA. Leflunomide may also be used to treat certain cancers, such as leukemia.
  
  
• Gold salt compounds: auranofin (Ridaura), aurothioglucose (Solganal), aurothiomalate or gold sodium thiomalate (Aurolate, Myochrysine). Rarely used to treat RA and other diseases (e.g., psoriatic arthritis). Gold salt compounds can be injected or taken orally. How they work is unclear, but they are believed to interfere with white blood cells which cause joint damage and inflammation. Gold compounds cannot reverse pre-existing joint damage or deformities. Regular blood and urine tests are often given to monitor for possible serious side effects, including kidney problems.
  
  
• Penicillamine (Cuprimine, Depen). A distant relative of the antibiotic penicillin. Given orally, penicillamine is rarely used to treat RA. Penicillamine is thought to change the function of white blood cells that cause damage in joints. However, the mechanism through which this occurs is unclear.  Penicillamine may be given along with nonsteroidal anti-inflammatory drugs (NSAIDs) in some cases. Gold salt compounds and penicillamine should not be taken together because of increased risk of side effects to the kidneys.
  
  
• Cyclosporine and azathioprine (Sandimmune, Neoral and Imuran). Originally manufactured to prevent rejection of transplanted organs by suppressing the immune system. These drugs may also be used to treat RA in some cases.   

Other DMARDs include chlorambucil (Leukeran) and cyclosphosphamide (Cytoxan), which are used mainly to treat cancer, and mycophenolate (CellCept), which is used mainly to prevent rejection of a transplanted organ. They may sometimes be prescribed for severe renal or other organ disease.

Tumor necrosis factor (TNF) inhibitors such as adalimumab (Humira), etanercept (Enbrel) and infliximab (Remicade) are sometimes grouped in with DMARDs but generally are considered to be part of a related class of immunosuppressive drugs called biologic response modifiers (BRMs). They also treat conditions such as RA and psoriatic arthritis, and their benefits and risks may be similar to those of DMARDs.