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.

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)

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)

Antimalarials (Plaquenil, Hydroxychloroquine)

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

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)

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)

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

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. Rheumatology, 09/06/2018. (Also see Treatments for Rheumatoid Arthritis)

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.

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