Disease-Modifying Anti_Rheumatic Drugs (DMARDs)

Medications for Scleroderma, Arthritis, Autoimmune and Rheumatic Diseases

Author: Janey Willis. Scleroderma is highly variable. See Types of Scleroderma. Read Disclaimer
Overview of DMARDs
Antimalarials (Plaquenil, Hydroxychloroquine)
Biologic Agents
Combination Therapy with DMARDs
Medicinal Metals

Overview of DMARDs

DMARDs are Disease-Modifying Anti-Rheumatic Drugs used for a variety of conditions from Irritable Bowel Disease to scleroderma. DMARDs include immunosuppressants, antimalarial drugs, anti-inflammatory metals, and biologic agents. (Also see What is Scleroderma?, Medical Overview, and Medications for Scleroderma, Arthritis, Autoimmune and Rheumatic Diseases)

Immunosuppressants fall under a category of drugs referred to as DMARDs (Disease-Modifying Anti-Rheumatic Drugs). ISN.

Scleroderma Treatments and Clinical Trials ISN.

Safety of treatments for primary Sjögren’s syndrome. Synthetic DMARDs have not shown much efficacy in earlier studies, while biologic DMARDs show promising results regarding efficacy and cause mostly mild adverse events. PubMed, Expert Opin Drug Saf, 01/25/2016. (Also see Treatments for Symptoms of Sjögren’s Syndrome)

Referral patterns, diagnosis, and disease management of patients with axial spondyloarthritis (SpA): results of an international survey. Referral patterns, diagnosis, and disease management for axial SpA were similar among rheumatologists and disease-modifying antirheumatic drugs were commonly prescribed for axial SpA patients. PubMed, J Clin Rheumatol, 2014 Dec;20(8):411-7.

Antimalarials (Plaquenil, Hydroxychloroquine)

Plaquenil when taken along with doxycyline causes demonstrable weight gain as a long term side effect.

Just How Common Is Hydroxychloroquine (HCQ) Retinopathy? There remains considerable debate about the safety of HCQ and the exact prevalence of retinopathy resulting from its use. Medscape, 04/07/2015.

Abnormal Weight Gain and Gut Microbiota Modifications Are Side Effects of Long-Term Doxycycline and Hydroxychloroquine Treatment. The results of the present study demonstrate abnormal weight gain as a side effect of long-term treatment with doxycycline and hydroxychloroquine. Moreover, it exhibits a reproducible effect on the community structure of the gastrointestinal microbiota in humans. PMC, Antimicrob Agents Chemother, 2014 Jun; 58(6): 3342-3347.

Significant retinopathy risk with long-term hydroxychloroquine. Long-term use of hydroxychloroquine may carry a significant risk of toxic retinopathy. Healthy Living, 10/16/2014.

Hydroxychloroquine Use Is Associated with Lower Odds of Persistently Positive Antiphospholipid Antibodies and/or Lupus Anticoagulant in Systemic Lupus Erythematosus. This is the first study to show that hydroxychloroquine (plaquenil, HCQ) use is associated with lower odds of having persistently positive lupus anticoagulant (LAC) and/or antiphospholipid antibodies. (aPL). The Journal of Rheumatology, Vol. 40, No. 1 30-33, August 1, 2012. (Also see Antiphospholipid and Lupus Treatments)

Plaquenil (Hydroxychloroquine). Hydroxychloroquine is classified as an anti-malarial drug. It is similar to chloroquine (Aralen) and is useful in treating several forms of malaria as well as lupus erythematosus and rheumatoid arthritis.

Biologic Agents

Biologics or biologic agents are biologic response modifying agents that block specific pathways and signals of inflammation. Some of the biologics used to treat rheumatic diseases include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), abatacept (Orencia), and rituximab (Rituxan). ISN.

Overview of Biologic Agents
Alemtuzumab (Campath)
Etanercept (Enbrel, Benepali)
Infliximab (Remicade)
Rituximab (Rituxan)
TNF Inhibitors

Combination Therapy with DMARDS

Impact of disease activity and treatment of comorbidities on the risk of myocardial infarction (MI) in rheumatoid arthritis. C–reactive protein (CRP) was associated with risk of MI and the results underline the importance of tight disease control taking not only global disease activity, but also CRP as an individual marker into account. Bio Med Central, Arthritis Research & Therapy, 08/05/2016. (Also see Symptoms and Complications of Rheumatoid Arthritis)

Treatment patterns and costs for anti–TNFα biologic therapy in patients with psoriatic arthritis. While the majority of patients received only one line of anti–TNFα therapy, a subset of patients switched to multiple lines of therapy during the 3–year follow-up period. BMC Musculoskeletal Disorders, 06/14/2016. (Also see Psoriasis and Psoriatic Arthritis)

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs(sDMARDs and bDMARDs): 2013 update. EULAR's most recent consensus on the management of RA with sDMARDs, glucocorticoids and bDMARDs. PubMed, Ann Rheum Dis, 2013 Oct 25.

Medicinal Metals: Gold, Platinum

Gold and some other metals have been proven to suppress the inflammatory process. DMARDs such as Auranofin and Gold sodium thiomalate are forms of gold used to treat rheumatic diseases such as rheumatoid arthritis.

Gold Preparations (Ridaura, Myochrysine, Solganol). Patient Information. American College of Rheumatology.


Sulfasalazine (Azulfidine) is an anti-inflammatory medication that belongs to a class of drugs called sulfa drugs. Sulfasalazine is also known as a disease modifying antirheumatic drug (DMARD) because it not only decreases the pain and swelling of arthritis but also may prevent damage to joints and reduce the risk of long term disability. Patient Information. American College of Rheumatology.

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