Disease-modifying Anti-rheumatic Drugs (DMARDs)

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Disease-modifying Anti-rheumatic Drugs (DMARDs) are commonly used for treating rheumatoid arthritis. Such type of drug is also used for treating other diseases, for instance psoriatic arthritis and systemic lupus erythematosus. DMARDs help relieve pain, decrease inflammation, reduce or prevent joint damage and maintain joint structure and function.

 

Mechanism of action

To suppress overactive immune system for relieving pain and inflammation, reducing joint damage and maintaining joint structure and function.

 

Points to Note

It takes several weeks or months for DMARDs to present observable effects; they cannot provide immediate relief.

DMARDs are used in combination with other drugs to achieve faster relief of symptoms, such as analgesics, non-steroidal anti-inflammatory drugs and steroids.

 

Drug Name Common Side Effects (≥1%) Points to Note
Methotrexate
  • Upset stomach
  • Sore mouth
  • Affect blood count
  • Increase risk of infection
  • Affect liver or lung function
  • Usually taken once per week
  • Concomitant use of folic acid may reduce the risk of certain side effects
  • Chest x-ray is recommended before beginning treatment
  • Avoid in pregnant and breastfeeding women, or patients with impaired immunity or liver function.
  • Caution in patients with renal impairment
  • Requires regular monitoring of complete blood count, liver and kidney function
Sulphasalazine
  • Headache
  • Nausea or vomiting
  • Reduce appetite
  • Skin rash
  • Affect blood count
  • Normal if body fluid such as urine, tears and sweat develop an orange tinge, and it may stain clothing or contact lenses.
  • Drink plenty of fluids while taking the medication
  • To be taken after meal
  • Sustained-release tablets should be swallowed on whole
  • Avoid taking antacids
  • Requires regular monitoring of complete blood count
  • Sensitivity to sunlight
Hydroxychloroquine
  • Nausea, vomiting and diarrhea
  • Increase risk of infection
  • Increase the risk of damage to the retina
  • Skin pigmentation
  • To be taken after meal
  • Perform eye check every year
  • Caution in patients with G6PD, renal and hepatic impairment, Pregnancy and lactation.
  • Requires regular monitoring of complete blood count
Leflunomide
  • Headache
  • Nausea, vomiting and diarrhea
  • Rash
  • Hair loss
  • Affect liver function
  • Increase risk of infection
  • Avoid in pregnant and breastfeeding women, patients with impaired immunity or liver function
  • Avoid alcohol
  • Affect blood count
  • Requires regular monitoring of complete blood count and liver function
Azathioprine
  • Nausea and vomiting
  • Affect blood count
  • Increase risk of infection
  • To be taken with or after meal
  • Affect liver function
  • Requires regular monitoring of blood indicators, liver and renal function
  • Caution in pregnant and breastfeeding women, and patients with impaired immune system or liver function
Cyclosporine
  • Nausea, diarrhea
  • Hypertension
  • Affected renal function
  • Increased hair growth
  • Increased risk of infection
  • Requires regular monitoring of blood pressure and renal function
  • Avoid grapefruit juice
  • Caution in patients with uncontrolled hypertension and impaired renal function