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.

The risk of malignancy and its incidence in early rheumatoid arthritis (RA) patients treated with biologic DMARDs. In early RA patients, bDMARD use decreases the overall risk of developing malignancies; however, it does not affect the risk of developing hematologic malignancies. PubMed, Arthritis Res Ther, 2017 Dec 15;19(1):277. (Also see Treatments for Rheumatoid Arthritis)

Dosing down and then discontinuing biologic therapy (bDMARD) in rheumatoid arthritis (RA): a review of the literature. In patients who have achieved low disease activity or remission, down–titration and discontinuation of bDMARD therapy may be attempted, with careful monitoring. PubMed, Int J Rheum Dis, 12/04/2017. (Also see Treatments for Rheumatoid Arthritis)

Evaluation of a patient decision aid (PtDA) for initiating disease modifying anti–rheumatic drugs. The PtDA can be a valuable aid in improving patient participation in decision–making about disease modifying anti–rheumatic drugs (DMARDs). BioMed Central, Arthritis Research & Therapy, 10/28/2016.

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.

Metabolic and cardiovascular benefits of hydroxychloroquine (HCQ) in patients with rheumatoid arthritis (RA) : a systematic review and meta–analysis. HCQ may benefit the metabolic profile and to a lesser extent cardiovascular events in patients with RA, which suggests its usefulness combined with other conventional synthetic disease–modifying antirheumatic drugs. PubMed, Ann Rheum Dis, 09/25/2017. (Also see Treatments for Rheumatoid Arthritis)

Hydroxychloroquine (HCQ) as an anti–thrombotic in antiphospholipid syndrome. The mechanisms of action of HCQ, and clinical and experimental data in systemic lupus erythematosus (SLE) and APS are discussed. PubMed, Autoimmun Rev, 2015 Apr;14(4):358-62. (Also see Antiphospholipid and Treatments for Lupus)

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.

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)

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.

Go to FDA Warnings

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