Traditional DMARDS

Reviewed by: HU Medical Review Board | Last Reviewed: May 2022 | Last updated: June 2022

Axial spondyloarthritis (AxSpA) is a chronic, progressive condition. There is no cure, but treatments are available to help you manage the condition. Because there is no cure, the goals of treatment are to:1

  • Maximize quality of life
  • Prevent or slow progressive structural damage
  • Control symptoms and inflammation
  • Preserve mobility

Medicine is one of the treatments used for AxSpA spectrum conditions. There are different kinds of drugs available for the AxSpA spectrum, and what works for one person may not be effective for another.

One class of drugs that can be used in the treatment of AxSpA spectrum conditions is called disease-modifying antirheumatic drugs (DMARDs). DMARDs are often used for inflammatory or immune diseases. There are 2 main kinds of DMARDs: traditional (also called synthetic or conventional) and biologics.2

How do traditional DMARDs work?

Traditional DMARDs work in different ways. The inflammatory process includes several pathways that result in inflammation. DMARDs work by interfering with this process. They can be given by mouth or injection.2

Traditional DMARDs can work on different parts of this process and are not as precise or selective as biologic DMARDs. Traditional DMARDs broadly restrict and affect your immune system. This is why it is important to be monitored while taking them.2,3

While DMARDs have been effective in some people, there is no proof that these drugs actually modify the disease or slow it down.

Examples of traditional DMARDs

There are different formulations of traditional DMARDs. The most common include:2,4

  • Methotrexate
  • Sulfasalazine
  • Hydroxychloroquine
  • Leflunomide

What are the possible side effects of traditional DMARDs?

Side effects can vary depending on the specific drug you are taking. Possible side effects of traditional DMARDs include:4

  • Upset stomach, nausea, or vomiting
  • Low blood cell counts
  • Liver problems
  • Skin rash
  • Headaches
  • Liver problems
  • Decreased appetite
  • Infection

These are not all the possible side effects of DMARDs. Talk to your doctor about what to expect or if you experience any changes that concern you during treatment with DMARDS.

Things to know about traditional DMARDs

Because traditional DMARDs broadly affect the immune system, you will need to be monitored for signs and symptoms of infections. This is because they can become serious very quickly.

DMARDs are not right for everyone. Before taking a traditional DMARD drug, tell your doctor if you:

  • Have an active infection
  • Have a pre-existing condition like leukopenia (low white blood cell count)
  • Have chronic liver disease
  • Have immunodeficiency syndrome
  • Are pregnant or breastfeeding

Additional therapy/additional treatment options

If one conventional DMARD does not work for you, you might want to try another one. Even though one may not be right, that does not mean that another one will not be effective.

If you find that DMARDs are not right for you, other treatments for AxSpa spectrum conditions are available. This includes non-drug treatments like physical therapy and various lifestyle changes. Talk with your doctor about your experience so you can find the right treatment for your symptoms.

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