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.

COVID-19 in Patients with Inflammatory Arthritis: A Prospective Study on the Effects of Comorbidities and DMARDs on Clinical Outcomes. Further work is needed to understand whether immunomodulatory therapies affect COVID-19 incidence. PubMed, Arthritis Rheumatol, 07/28/2020.

Effect of disease-modifying anti-rheumatic drugs (DMARDs) on bone structure and strength in psoriatic arthritis (PsA) patients. Despite longer disease duration, bDMARD-treated PsA patients benefit from higher bone mass and better bone strength than PsA patients receiving methotrexate or no DMARDs. PubMed, Arthritis Res Ther, 2019 Jul 3;21(1):162. (Also see Psoriasis and Psoriatic Arthritis)

Ability of disease–modifying antirheumatic drugs to prevent or delay rheumatoid arthritis (RA) onset: a systematic literature review and meta–analysis (MA). This MA demonstrates that early therapeutic intervention may significantly reduce the risk of RA onset in this very first phase of the disease. PubMed, Ann Rheum Dis, 06/08/2018. (Also see Treatments for Rheumatoid Arthritis)

Optimizing conventional DMARD (cDMARD) therapy for Sjögren's syndrome (pSS). The unique and potent mechanisms of action to target immunopathology in pSS suggests that optimizing cDMARDs for treatment of pSS is worthwhile. ScienceDirect, Autoimmun Rev, 2018 May;17(5):480-492. (Also see Treatments for Symptoms of Sjögren’s Syndrome)

Antimalarials (Plaquenil, Hydroxychloroquine)

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

The influence of obesity on hydroxychloroquine (HCQ) blood levels in lupus nephritis patients. It was advised to consider the use of 2016-AAO dose of HCQ as per the ideal body weight for this group of patients. PubMed, Lupus, 2021 Jan 5;961203320985214. (Also see Symptoms and Complications of Lupus)

Novartis halts malaria drug trial against COVID-19 amid participant shortfall. Novartis is halting its trial of malaria drug hydroxychloroquine against COVID-19 after struggling to find participants, as data emerged from other studies raising doubts about its efficacy. Reuters Health, 06/19/2020.

Retinal Complications in Patients with Systemic Lupus Erythematosus Treated with Antimalarial Drugs. Just over 5% of patients developed antimalarial retinal complications, over an average of 12.8 years, but no cases were detected in the first 5 years of therapy. PubMed, J Rheumatol, 2020 Apr;47(4):553-556. (Also see Symptoms and Complications of Lupus)

Clinical and Structural Efficacy of Hydroxychloroquine (HCQ) in Rheumatoid Arthritis (RA): A Systematic Review. Combining HCQ with other DMARDs could provide some clinical improvement in patients with RA. PubMed, Arthritis Care Res (Hoboken), 2020 Jan;72(1):36-40. (Also see Treatments for Rheumatoid Arthritis)

HIBISCUS: Hydroxychloroquine for the secondary prevention of thrombotic and obstetrical events in primary antiphospholipid syndrome. Hydroxychloroquine (HCQ) appears as an additional therapy, as it possesses immunomodulatory and anti-thrombotic various effects. PubMed, Autoimmun Rev, 2018 Dec;17(12):1153-1168. (Also see Antiphospholipid and Treatments for Lupus)

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
Abatacept (Orencia)
Alemtuzumab (Campath)
Etanercept (Enbrel, Benepali)
Infliximab (Remicade)
Rituximab (Rituxan)
TNF Inhibitors

Combination Therapy with DMARDS

Comparative Risk of Cardiovascular Events (MACE) With Biologic and Synthetic Disease-Modifying Antirheumatic Drugs (csDMARDs) in Patients With Rheumatoid Arthritis: A Systematic Review and Meta-Analysis. Based on meta-analysis, as compared to tumor necrosis factor inhibitors, tocilizumab may be associated with a reduced risk of MACE, whereas csDMARDs may be associated with an increased risk of MACE and stroke. PubMed, Arthritis Care Res (Hoboken). 2020 Apr;72(4):561-576. (Also see Symptoms and Complications of Rheumatoid Arthritis)

The effects of methotrexate (MTX) and hydroxychloroquine (HCQ) combination therapy vs methotrexate monotherapy in early rheumatoid arthritis (RA) patients. In contrast to indirect comparison review data, MTX–HCQ seems somewhat more effective after 6 months than MTX monotherapy in early RA patients. PubMed, Rheumatology (Oxford), 2019 Jan 1;58(1):131-134. (Also see Treatments for Rheumatoid 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.

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