Without treatment, joint inflammation can cause permanent damage. Doctors know that it is wise to prescribe a disease-modifying antirheumatic drug (DMARD) before such damage occurs. People newly diagnosed with an inflammatory form of arthritis, such as rheumatoid arthritis, may be prescribed a DMARD upon their diagnosis.
Another reason DMARDs should be started early is that, although they are generally effective, they take a long time to show results. For example, hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine) may take up to three or four months before effects are noticed. Other drugs, such as methotrexate, work more quickly, but often not quickly enough. For that reason, doctors frequently prescribe an additional drug – such as a corticosteroid or an NSAID – to help control pain and inflammation while the DMARD starts to work.
DMARDs are most commonly used for rheumatoid arthritis, but some are also used for juvenile RA, ankylosing spondylitis, psoriatic arthritis and lupus. Some, such as chlorambucil (Leukeran), mycophenolate mofetil (CellCept) or cyclosphosphamide (Cytoxan), are used mainly to treat severe organ disease, such as kidney disease caused by lupus or vasculitis. The dosages listed in this chart are for those with RA; your dosage may vary depending on your specific condition and factors like disease severity, age, body weight and other medications you are taking.
Only three DMARDs – auranofin (Ridaura), leflunomide (Arava) and Azulfidine – were actually developed for rheumatoid arthritis. The others were borrowed from different areas of medicine: Hydroxychloroquine (Plaquenil) is a malaria drug, chlorambucil (Leukeran) and methotrexate are cancer medications and cyclosporine (Neoral) originally was developed to keep the body from rejecting transplanted organs.
Because DMARDs suppress the immune system, always watch for signs of infection – chills, fever, sore throat or cough – and report them to your doctor. And check with your doctor before getting any vaccinations.
Drug Guide: DMARDs
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Beverly
26 Feb 2010, 09:28
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| Can anyone that has taken placquenil for RA share the side effects they have experienced, in particular...hair loss? Also, how long did it take before hair loss was noticed, and will it reverse when the drug is stopped? I know asking this may sound like simple vanity, but my mother has auto-immune disease and she has dealt with this problem all her life. And since it was many years ago when it began, it has been a true personal and social nightmare for her. She is a much stronger person than I am, and Im not sure I would be able to cope. I've been taking mobic but my RA is getting so much worse and I'm going to need to begin other treatment very soon. I'm trying to look at all my options. Also, does anyone know if plaquenil will help with fatigue? THAT in addition to the pain and stiffness is also MUCH worse and very difficult to deal with. Thanks so much for any info you can provide. |
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Bella
11 Feb 2010, 16:32
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| I was diagnosed with RA 7 weeks ago and instantly put on Methotrexate. I take 15mg a week. I was told I should have my blood tested every 4 weeks or so to check liver/kidney funtion. The Dr has not done that and I do not see him for another 4 weeks. Should ask him or even demand a blood test then? Taking the MTX scares me. I feel tired and my blood pressure has gone up dramatically. I also have a lot of nausea. I am 39 yo and trying to learn all I can about RA. |
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Linette
06 Jan 2010, 01:03
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| I have been diagnosed in 2007 with RA however I have been on many meds. I am now on Prednisone 5 mg per day, Lodine 800 mg per day and Plaquenil 400 mg per day. I have been on Plaquenil for well over a year and I am still experiencing a great deal of pain. Flares are occurring more often especially now that it is winter and my stiffness and swelling in my hands last most days until well after noon. I was also on Methotrexate 15mg a week but it did not sit well with me. I also suffer from extreme fatigue all the time. Some weekends I do not (and cannot) get out of the bed. And to make matters worse, in the summer when I go out to my daughter's soccer games or I am just outside, the sun causes me to get horrible mouth/lip sores that are very painful. I sometimes feel like I am complaining too much but this is painful and causes me to be just plain exhausted. I have set up an appt with a new RA doctor however that is not until May. That is the soonest I could get in. I am concerned because the symptoms seem to be getting worse and more frequent. I don't know what to do. Help! I see many talking about fish oil -- what is the scoup on that?? |
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Lynne
05 Jan 2010, 15:26
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| Hello All, I was diagnosed w/RA a year ago. My Reumy Dr. instantly put me on Plaquenil (200mg 2x day) but also added Fish Oil tabs (6 per day) Vit D & E and SamE. This combo has worked beautifuly for me...no side effects..and no problems with my immune system. I have been in remission for 3 months (no swelling or pain) but now feel it coming back. My Dr. wants to add methotrexate as the next step, I'm nervous about adding such a toxic drug to my system. Right now I'm focused on trying to keep a positive attitude and just dealing with things on a day to day basis! I wish better health to everyone! Lynne |
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sheila
05 Jan 2010, 11:33
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| i was diagnosed with RA and am 41yrs old. for two years they just kept on saying it was fibromyalgia. all my blood test came back neg. after research and a new dr. i am finally getting treated for the right thing and am taking Plaquenil 200mg a day and the weather is killing me besides ive been in severe pain for the past few years and can not work. i take neurontin, valium, pristiq, and norco. does anyone have any ideas they used that work? i hate popping pills. my pristiq i do need and valium since i suffer from chronic depression/anxiety from along time ago. i do take fish oil.... |
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cheryl
29 Dec 2009, 17:28
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| I was diagnosed with RA officially in Oct. this year. Had many tests
because no one seemed to have an answer, everything from MS to lupus, then
finally the right doctor saw the right blood test and has started to treat
me. Only on methotrexate 10 mg. once a week. Also did a round of
prednisone which gave relief after 2 weeks. Have had injections in my hips
and spine. Lasted about 2 weeks. I'm a mail carrier and now that the
weather is cold aches seem worse. See doctor tomorrow for updates. |
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Katz
15 Dec 2009, 14:46
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| Ann, I am also afraid to have to start taking methotrexate. Fortunately, I don't have to. I've been on Plaquenil for many, many years with great results. It is the safest of all the DMARD's (although some folks don't consider it a DMARD, my rheumy and I do). Even though my numbers were off the charts, you'd never know I had RA if you saw me. I do take Pred. and Advil during flares which are few and far between. Good luck. |
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Ray
03 Dec 2009, 09:10
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| Pat, I have had AS for approx. 55 years and was told by my Rhematologists that I had a relatively mild case. Anklosing Spondilytis (AS) can be and frequently is, a very serious disease, with possible heart valve problems, eye infections and extremely painfully hip/back/ribs/shoulder and neck joint pain. The good news is it tends to do all its damage over a forty/fifty year period and than burns out or goes away. The bad news is that all the damage it caused over that period now starts to flare up as a result of Osteoarthritis and I am once again experiencing severe, debilitating pain with weather changes. This year I had both shoulders completely replaced and my Dr. is now talking about doing surgery on my neck. I am going back to my Rhematologist to see if there is some other medicine that can help and not kill me in the process. There are a number of very helpful medicines but they can also be dangerous to your health/life but, had they been available 30 years ago, I would have undoubtedly tried them. Good luck Pat and hopefully your disease will a relatively mild case. |
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Kimberley
01 Dec 2009, 16:32
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| I have had RA since 1969,I was 9years old. I have been on alot of different treatments. Steroids the longest,as back then the docs didnt know much about it. If you stay on those steroids to long it is very hard to get off them. I was taking them for about 30years.I finally got off them, this year. I am on Enbrel currenty and it is working great! Just keep a positive attitude and KEEP moving no matter what. |
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Lexy
16 Nov 2009, 20:02
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| I've been recetly diagnosed with spotty RA. My RAF & CCP tests are positive. I had remission for 9 motnhs until October when weather turned cold & rainy. I am on Minocycline 100mg 3 days/week. Has anyone else tried antibiotic therapy? Any side effects? |
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Mickey
15 Nov 2009, 09:48
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| Have been on 20 mg methotrexate weekly for about 2 years now and 6 months
ago we added Humira. The RA and PSA are reasonably under control, except
one hand is useless,but my blood tests just recently indicated a problem.
My doctor is now adjusting the methotrexate to a lower dosage. Cannot stress enough the importance of blood tests if you are on methrotrexate and another biological. |
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Vikki
03 Nov 2009, 11:39
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| I was diagnosed with very severe RA almost 5 years ago and with fibromyalgia about 4 months ago. I have been on several of the biologics (Humira, Enbrel, etc) and cannot tolerate. I take methotrexate 25mg injections weekly along with Plaquenil and Arava. I also take Cymbalta for the fibro and depression. All of these medications can potentially be liver toxic, so I do not drink except maybe a single glass of wine on very rare occasions. I take Aleve for pain only if I need to, but I live with the pain for the most part. I stay as active as possible, and even on the days when I don't want to get up, I do, and do as much as I can. I have seen firsthand what the future holds for me, (I'm a nurse) and that alternative is not an option. The thought of being in a body that doesn't work with a mind that does scares the hell out of me. Good luck to all of you!!!!! |
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Ann
20 Oct 2009, 13:12
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| I've had arthritis since 1987 or so. After trying many drugs (other than
that wonderful Prednisone that they wouldn't leave me on even at a very low
dose), we found that Naprosyn worked best for me. Now, 20-plus years
later, I'm getting worse and worse. I think the Naprosyn is losing its
effect. This year, my newest rheumie confirmed that I do have RA and wants to put me on Methotrexate, which he says is the next drug of choice. For some reason that drug really frightens me, so I've put off taking it. I've heard it gives you mouth sores, but I'm already dealing with that (which I think is due to the Naprosyn), hair loss, and weight gain to mention a few side effects that I remember reading about. I would be much more willing to try Celebrex, but he doesn't seem to want to go there. I'm wondering if I should try taking 1-2 Tb daily of flaxseed oil, which I hear is good for RA and constipation (another problem caused by the Naprosyn). |
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kristine
20 Oct 2009, 13:03
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| I was diagnosed with RA in June 2009 during a major flare. Ive been on 15mg Methotrexte once a week and have had great results. I actually feel better than I have in years. I was on 5-20 mg of prednisone(on and off) daily for several weeks as well but have been off that for about a month now. My pain is very minimal as I believe the methotrexate is really doing it's job. It took about 3-4 weeks for it to really kick in. |
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Mike
14 Oct 2009, 03:41
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| Just digo with ploymyalgia rheumatica. Doc (rheumatologist) put me on
prednisone 5 mg 2 a day. And hydroxycloroquine 200mg 2 per day. Don't
know much about the polymyalgia or any of the RX for helping the pain.
Would appreciate any support and advise you have to give. Thanks MIKE |
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Barb
13 Oct 2009, 17:27
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| Hi Was reading all your comments!! I have RA It's been 12 years and plenty of up's and downs Now with this weather being cooler I feel the ache's I am on Arava and also Enbrel 2x week I give myself the shot. Every day is different, when you have no pain enjoy as if it might be your last and you wake up the next day and a flare-up and no use to any one. Prednisone is great the wonder pill also has side affect's I have cataract's. So hope every one finds their way!!! Think Positive. |
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Christina
05 Oct 2009, 16:46
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| I was just diaganosed with RA no one in my family have had RA. I have Been put on a couple of meds. Im taking methotrexate now so far its not working yet. I take 4 pills once aweek.Does anybody now how much longer I have before I get some relief? |
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Tessie
17 Sep 2009, 12:23
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| This note is response to Stephanie's note from July 21st. I've been taking Plaquenil for over 4 years for RA and have had no problems concerning a lowered immunity. I started at 400mg plus a steroid pill for about 2 months. I was weened off the steroid. The Plaquenil takes a few months to really kick in. After about a year I started weening myself down from 400mg to 300mg (cut a pill in half) to eventually just one pill. To help with the rumbling stomach issues I take the Plaquenil in the late evening about 1/2 hour or so before bed. That really helps. Unfortunately I've recently went back up to 300mgs and was just prescribed Methotrexate because I've been experiencing a lot of stiffness, swelling and pain for the last 6 months or so. |
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Ken
15 Sep 2009, 12:53
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| Joyce, It depends on your prescription, but methotrexate is not terribly expensive. At Costco, it's $17 for (30) 2.5mg pills. This would last for ten weeks for me. (Three pills a week.) Ken |
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joyce
19 Aug 2009, 12:16
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| hi, I was just diagnosed with RA two weeks ago. the Dr. i saw gave me prednisone to take for 1 week just to keep inflam. down. boy does that work fast (although i was off the charts on my titer and i am RA+ he said i had a normal range sed rate-- of course i finally got in after a horrible flare was over. I am uninsured and make too much to get assistance, I hear the meds are very expensive, i have yet to get into a Rhumatologist. anyone tell me the price of meds with no ins??? eg: methatrexate hell- it's gonna cost from 300 to 650 just to visit the DR!!! I'm glad there is a support group out there! thanks joyce |
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Pattie
04 Aug 2009, 09:46
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| I was diagnosed with Psoriatic Arthritis about 7 years ago and am being treated by a Rheumatologist. At first I was given Enbrel and methotrexate. The methotrexate helped with the psoriasis. The Enbrel stopped working so my doctor started me on Rhemicaid. It works like a charm. I go in to the hospital once every 8 weeks and get my infusion. I heard that methotrexate was a very powerful drug and you can not drink even 1 glass of wine ever. Since I like wine I started to ween myself off the methotrexate. I was fine with just the Rhemicaid but I am now having spouts of psoriasis again. I have an appointment with a Dermatologist in a couple of weeks so I will see what he suggests. I don't want to go back on Methotrexate... |
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Mary K
03 Aug 2009, 09:06
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| I have a split diagnosis: Monoundifferentiated arthritis of the rt clavicle. My rheumatologist says likely atypical rheumatoid arthritis OR spondyloarthropy. She is recommending methotrexate. Prednisone and cortisone injections have provided some relief. My other primary symptom is fatigue. Is there anything else I should ask or try before methotrexate? Sounds like I would have to be on that for the rest of my life? |
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Stephanie
21 Jul 2009, 09:34
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| Hi- I've been officially diagnosed with RA about 3 weeks ago. I'm an active 36 yr old woman. My mom has RA pretty bad and I just don't want to end up like this. I feel horrible for her because she just can't seem to find a drug that helps. I've been on Plaquenil for almost 3 weeks and just recently added a 2nd pill making it 400mg/day. Just when my body was getting used to 200mg/day now I'm dealing w/the side affects. I don't like them and I'm really hoping this works. I'm curious about adding more fish oil to my diet as mentioned above. But what I did NOT know what that this drug lowers your immune system. Anyone have any issues with this? Thanks, Steph |
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khyati
24 Jun 2009, 03:11
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| hi,I am just 22 and have never taken any medicine before..i got a severe pain in my back and doc suspected that one small surgery may cure it permanently..but i m relly scared of the surgery..should i go for it... |
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Helen Moss
16 Jun 2009, 16:43
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| I am 53 years old and i was diagonise with RA a year ago at first i was put on meteroate I lost too much weight and then i was put on humaria it helped alot I needed something else So i was put on arava I've been taking it for a week now so far so good I barely have any pain now I am just looking for the side affects now I hope It goes ok. |
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A Daley
16 Jun 2009, 01:44
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| I was diagnosed with RA back in early 2007. Dr suggested methotroxate
originaaly. I did some research and found that Adelaide University did a
study on RA and the benefits of taking liquid fish oil. I spoke to my Dr about not going straight onto methotroxate at first and suggested we try a lower solution to my RA. This was agreed and I went onto Plaquenil and on my own accord I went onto at the same time 20ml of liquid fish oil a day. Within 3 months my RA improved to the degree that I play golf at least 3 times a week. I only see my Dr once a year now. At present I do not suffer from inflammation. I believe fish oil has worked for me and suggest others might consider it. |
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Laurie
10 Jun 2009, 09:38
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| I have Behcets, and use a few DMARDS. I find alot of support with YAHOO
groups, lots of others can share and support. Great support communities
there. Laurie |
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pat
02 Jun 2009, 20:11
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Hi. I just found out I have Ankylosing Spondylitis. Is there anyone out there who has this? I never heard of it until now, and I would like to hear from someone who has it also. thanks, Pat |
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Shelly
02 Jun 2009, 18:50
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| No, J. Kato you are not the only man with arthritis. My husband has
arthritis in his back. He has had three back surgeries and the doc
suspects that is where it came from. They haven't told him what kind it
is, and I suspect we'll never know. He's only 31, but after all these
surgeries it seems par for the course. If I were you I would educate
myself prior to the next appointment (it looks like you already are), write
down questions you have for the doc so you don't forget them, ask the doc
what tests could be ran to see if it actually is arthritis or a pinched
nerve, then insist she run the tests she tells you about. See if there are
any tests suggested online. If you are not happy with the results of your
next appointment it might be time to seek a second opinion if that is at
all possible. I know it hurts and I'm so sorry. I hope this helps even a
little bit. Shelly |
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J. Kato
30 May 2009, 05:15
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| Ok... My spelling isn't very good and its just after six am... been up all
night. Now... To correct a post I made a few minutes ago (somewhere else I
think), Here goes... Excuse me, BUT... Am I the only man on earth that has arthritis? I certainly do not mean to offend anyone, but I'm feeling a bit alone here. I have recently been told by my doctor (a woman) :O) at the VA that I have arthritis in my back. I have no idea what kind it is, and I understand there are over a hundred kinds it could be. In many cases of arthritis, they (doctors) don't have a clue as to what causes it. About three months ago I began having severe back pain. It is now also in my left leg and foot and my right foot. It has began to affect my back and neck also. One doctor said I had a "pinched nerve" and arthritis. I have been given Ibuprofen and methocarbamol and a heating pad. It helps some, but not much. I am to see my doctor this June 22nd for father evaluation. Any suggestions? :O) Peace to all... Jack |
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Anette
19 May 2009, 18:32
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| Even a fue shot can give a flare-up. Didn't have enough info.before i had my annual flu shot. I was also just diagnosed. Do not get any vaccine before talking to your Dr. |
