Arthritis Treatment: What is a DMARD?

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Rheumatoid arthritis (RA) is the most common inflammatory form of arthritis, affecting approximately 2 million Americans. A recent study has shown that the incidence of the disease may be declining somewhat; nevertheless, RA remains a significant public health problem. This is due to the multisystem nature of the disease. RA is a chronic, systemic autoimmune disease for which there is no known cure. It has the potential to affect multiple organ systems including the heart, lungs, eyes, bone marrow, skin and peripheral nervous system. Treatment of rheumatoid arthritis begins with the diagnosis. Once the diagnosis is made, treatment can begin. Pain symptoms can be treated with non-steroidal...

Rheumatoide Arthritis (RA) ist die häufigste entzündliche Form der Arthritis und betrifft etwa 2 Millionen Amerikaner. Eine kürzlich durchgeführte Studie hat gezeigt, dass die Inzidenz der Krankheit möglicherweise etwas zurückgeht; dennoch bleibt RA ein bedeutendes Problem der öffentlichen Gesundheit. Dies liegt an der Multisystemnatur der Krankheit. RA ist eine chronische, systemische Autoimmunerkrankung, für die es keine bekannte Heilung gibt. Es hat das Potenzial, mehrere Organsysteme zu beeinflussen, einschließlich Herz, Lunge, Augen, Knochenmark, Haut und peripheres Nervensystem. Die Behandlung der rheumatoiden Arthritis beginnt mit der Diagnosestellung. Sobald die Diagnose gestellt ist, kann mit der Behandlung begonnen werden. Schmerzsymptome können mit nichtsteroidalen …
Rheumatoid arthritis (RA) is the most common inflammatory form of arthritis, affecting approximately 2 million Americans. A recent study has shown that the incidence of the disease may be declining somewhat; nevertheless, RA remains a significant public health problem. This is due to the multisystem nature of the disease. RA is a chronic, systemic autoimmune disease for which there is no known cure. It has the potential to affect multiple organ systems including the heart, lungs, eyes, bone marrow, skin and peripheral nervous system. Treatment of rheumatoid arthritis begins with the diagnosis. Once the diagnosis is made, treatment can begin. Pain symptoms can be treated with non-steroidal...

Arthritis Treatment: What is a DMARD?

Rheumatoid arthritis (RA) is the most common inflammatory form of arthritis, affecting approximately 2 million Americans. A recent study has shown that the incidence of the disease may be declining somewhat; nevertheless, RA remains a significant public health problem. This is due to the multisystem nature of the disease. RA is a chronic, systemic autoimmune disease for which there is no known cure.

It has the potential to affect multiple organ systems including the heart, lungs, eyes, bone marrow, skin and peripheral nervous system.

Treatment of rheumatoid arthritis begins with the diagnosis. Once the diagnosis is made, treatment can begin.

Pain symptoms can be treated with nonsteroidal anti-inflammatory drugs (NSAIDs). These help with symptoms, but do not change the course of the disease.

Disease-modifying anti-rheumatic drugs (DMARDS) are drugs that act on the disease itself. They slow and sometimes stop the progression of the disease. This is achieved by acting on the immunological disorders responsible for RA.

Examples of DMARDS used to treat RA include hydroxychloroquine (Plaquenil), sulfasalazine (Azulfidine), azathioprine (Imuran), cyclosporine (Neoral), and methotrexate. The latter drug is considered the workhorse or foundation upon which all other disease-modifying therapies are built. These are generally administered as oral pills or tablets.

Most of these chemical DMARDS were originally used to treat other diseases before finding a niche in RA.

In addition to chemical DMARDS, newer biological drugs, protein-based drugs that are synthesized to specifically target immune abnormalities, are also considered DMARDS. These biologics are administered either by subcutaneous injection or intravenously.

Thus, DMARDS are divided into two groups: non-biological DMARDS and biological DMARDS.

While the old approach was late use of DMARDs, the newer approach is to combine a chemical DMARD and a biologic drug early in the course of the disease, generally within the first three months of disease activity. The reason for this is that then there is the best chance of remission. In fact, early treatment can even lead to permanent remission in some cases.

All DMARDS have potential side effects including liver toxicity, bone marrow toxicity and kidney damage, among others in the case of chemical DMARDS.

Biologics increase the likelihood of infection, especially tuberculosis, and this requires screening and careful follow-up, central nervous system dysfunction, and many other potential problems.

Close monitoring by an experienced rheumatologist is mandatory. This reduces the likelihood of problems.

Inspired by Nathan Wei