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Disease-Modifying Antirheumatic drugs (DMARDs) 

Disease-Modifying Antirheumatic Drugs (DMARDs): Overview, Types, and Clinical Use

Disease-modifying antirheumatic drugs (DMARDs) are medications designed to slow disease progression in autoimmune and inflammatory conditions like rheumatoid arthritis (RA), psoriatic arthritis (PsA), and lupus. Unlike NSAIDs or steroids, which primarily reduce symptoms, DMARDs target the underlying immune mechanisms driving inflammation and tissue damage136.

Types of DMARDs

DMARDs are categorized based on their origin and mechanism:

Type	Examples	Mechanism
Conventional Synthetic (csDMARDs)	Methotrexate, sulfasalazine, hydroxychloroquine	Suppress inflammation via multiple pathways (e.g., purine metabolism inhibition, cytokine modulation)12.
Targeted Synthetic (tsDMARDs)	Baricitinib, tofacitinib, apremilast	Block specific molecular targets (e.g., JAK enzymes, PDE4)12.
Biological (bDMARDs)	Adalimumab, rituximab, tocilizumab	Target immune cells or cytokines (e.g., TNF, IL-6)12.

How DMARDs Work

DMARDs modulate the immune system to reduce inflammation and prevent tissue damage:

1. Immune Suppression: Inhibit overactive immune cells (e.g., T-cells, B-cells) or cytokines (e.g., TNF, IL-6)37.
2. Anti-Inflammatory Effects: Lower CRP, ESR, and rheumatoid factor levels16.
3. Joint Protection: Slow cartilage and bone destruction in conditions like RA57.

Clinical Applications

DMARDs are used for:

• Autoimmune Arthritis: RA, PsA, ankylosing spondylitis.
• Systemic Lupus Erythematosus (SLE): Hydroxychloroquine, methotrexate.
• Psoriasis: Apremilast, biologics like secukinumab12.
• Other Conditions: Crohn’s disease, sarcoidosis, myasthenia gravis1.

Treatment Considerations

1. Combination Therapy:
   • csDMARDs: Often combined (e.g., methotrexate + sulfasalazine + hydroxychloroquine) to enhance efficacy and reduce side effects12.
   • bDMARDs: Typically paired with csDMARDs (e.g., methotrexate + adalimumab)27.
2. Response Time:
   • csDMARDs: May take weeks to months to show effects26.
   • bDMARDs: Act faster (e.g., anti-TNF drugs reduce inflammation within days)27.
3. Side Effects:
   • Common: Nausea, liver toxicity (methotrexate), infections (immunosuppression)26.
   • Monitoring: Regular blood tests for liver/kidney function and infections27.

Alternatives and Adjuncts

• Steroids: Used short-term for acute flares17.
• NSAIDs: Manage pain but do not alter disease course36.
• Advanced Options: Cyclophosphamide or bone marrow transplants for refractory cases1.

Conclusion

DMARDs are cornerstone therapies for autoimmune and inflammatory diseases, offering long-term control by targeting immune dysregulation. Early initiation and personalized combinations improve outcomes, though side effects and response variability necessitate close monitoring127.

Consult with Our Team of Experts Now!

At DrStemCellsThailand (DRSCT)‘s Anti-Aging and Regenerative Medicine Center of Thailand, we provide tailored DMARD regimens and holistic care strategies for chronic inflammatory conditions. Consult our specialists today for personalized treatment plans. If you have questions about Disease-Modifying Antirheumatic drugs (DMARDs)  or would like more information on our services, consult with our experts today!

Consult with Our Team of Experts Now!

References

1. Wikipedia: DMARDs
2. Versus Arthritis: DMARDs
3. Medical News Today: DMARDs
4. Arthritis Foundation: DMARDs
5. Healthdirect: DMARDs
6. Cleveland Clinic: DMARDs