Overview
Disease-modifying antirheumatic drugs (DMARDs) are medicines that calm the overactive immune system in conditions such as rheumatoid arthritis, psoriatic arthritis and lupus. Unlike pain relievers, they treat the underlying inflammation and may help prevent joint damage.
Common conventional DMARDs include methotrexate, hydroxychloroquine, sulfasalazine and leflunomide. Targeted synthetic DMARDs, such as JAK inhibitors, are taken by mouth and act on specific immune pathways.
Watch and learn
Video: “Getting Started on Methotrexate : What You Should Know” from Johns Hopkins Rheumatology on YouTube. It loads from youtube-nocookie.com only when you press play. Shown for general education; GSMC did not produce it. Watch on YouTube
Video: “Treatment Options for Rheumatoid Arthritis | Johns Hopkins Rheumatology” from Johns Hopkins Rheumatology on YouTube. It loads from youtube-nocookie.com only when you press play. Shown for general education; GSMC did not produce it. Watch on YouTube
Captions: press the CC button in the video player to turn on captions. Some captions are generated automatically by YouTube and may contain errors.
How it is used
- Taken by mouth or, for methotrexate, sometimes by weekly injection
- Benefits usually build over weeks to a few months
- Often combined with other DMARDs or with biologics
Who it may be for
- Rheumatoid arthritis, psoriatic arthritis
- Lupus and Sjögren’s (often hydroxychloroquine)
- Some forms of vasculitis and other autoimmune diseases
Monitoring and safety
Regular blood tests check blood counts, liver and kidney function. Hydroxychloroquine requires periodic eye exams. Tell your rheumatologist if you are pregnant or planning pregnancy, as some DMARDs must be stopped in advance.
Possible side effects
- Nausea, mouth sores or upset stomach
- Liver or blood count changes (monitored with labs)
- Higher risk of some infections
- Specific risks vary by medicine; your rheumatologist will review them
Do not start, stop or change a medicine without talking to your physician.
Frequently asked questions
How long until a DMARD works?
Often 6 to 12 weeks, sometimes longer.
Can I drink alcohol on methotrexate?
Alcohol increases liver risk. Ask your rheumatologist what is safe for you.
Do I need vaccines?
Your rheumatologist may recommend certain vaccines before or during treatment.
This page is general patient education and does not replace advice from your own clinician. Individual results vary.