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Arthritis Arthritis Treatment

Treatments for Rheumatoid Arthritis: DMARDs

One of the most talked about treatments for rheumatoid arthritis (RA) involves the use of disease-modifying antirheumatic drugs or DMARDs. Studies show these medications can actually halt the underlying processes that cause rheumatoid arthritis by altering how the immune system functions.

In clinical trials, investigators have shown that patients have better clinical outcomes when the disease is diagnosed early and aggressive DMARD therapy is started immediately. The success with these drugs stems from the fact that they do more than just treat the symptoms of arthritis; DMARDs can also slow down or stop joint and tissue damage. It has even been suggested that a brief delay in the initiation of DMARD therapy can lead to more rapid joint destruction and loss of function over time.

However, it is important to note that DMARDs take time to work on the overall disease process, and their results may not be felt or seen for weeks or even months. For this reason, DMARDs typically are used with a nonsteroidal anti-inflammatory drug (NSAID) or a corticosteroid, which works on the inflammation, pain and swelling, and offers patients more immediate relief.

What are DMARDs?
Many types of drugs are classified as DMARDs. Some of these medications are traditionally used to treat other conditions, such as cancer or inflammatory bowel disease, or to reduce the risk of rejection of a transplanted organ. When they are used to treat rheumatoid arthritis, the doses are significantly lower and the risks of side effects tend to be considerably less. The various types of DMARDs include the following medications.

Chemotherapy Drugs
The most commonly used DMARD for rheumatoid arthritis is methotrexate. It is an immunosuppressive drug, taken by mouth or by injection that has proven highly effective at reducing the signs and symptoms of rheumatoid arthritis. Typically, it takes about four to six weeks for patients to experience a response to treatment. A trial of three to six months is usually suggested.

Methotrexate is usually well tolerated in low doses. The most common symptom is nausea, but the real concerns are hidden problems, such as severe toxicity to the liver and bone marrow. These potentially serious conditions can be detected and largely avoided with regular monitoring and blood testing. Doctors should also be on the lookout for a dry, nonproductive cough, which can be a sign of a rare lung toxicity. Methotrexate can impair fertility, decrease sperm count and cause menstrual dysfunction.

The drug works by suppressing the body's immune system, thereby reducing the inflammatory response. However, since immunity is suppressed, there is a greater likelihood for infection to develop. Any symptoms of infection should be reported to a physician. Moreover, patients with underlying immune deficiency diseases should not receive methotrexate.

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