Traditional DMARDS

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 maximize quality of life, prevent or slow progressive structural damage, and control symptoms and inflammation and preserve mobility.1

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

How do traditional DMARDs work?

Conventional DMARDs work via multiple mechanisms. The inflammatory cascade consists of combinations of critical pathways in order to result in inflammation; the DMARDs interfere with this process.2 Conventional DMARDs can work on different parts of this cascade and are not as precise or selective as biologic DMARDs.2 Conventional DMARDs broadly restrict and affect your immune system.3 This is why it’s important to be monitored while taking them.

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

Conventional DMARDs can be given orally or by injection.

Formulations of traditional DMARDs

There are different formulations of conventional DMARDs. What follows are the most common conventional DMARDs:2,4

  • Methotrexate
  • Sulfasalazine
  • Hydroxychloroquine
  • Leflunomide

What are the possible side effects of traditional DMARDs?

As with any medications, there may be side effects with conventional DMARDs. Sometimes these side effects are temporary, but sometimes they can be severe or serious and the drug may need to be discontinued. Talk with your doctor about any side effects you notice.

Possible side effects of these drugs can include:4

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

*This is not a complete list of side effects.

Because these drugs broadly affect the immune system, you will need to be monitored for signs and symptoms of infections, as they can become serious very quickly.

Things to know about traditional DMARDs

If you have an active infection, pre-existing conditions like leukopenia (low white blood cell count), chronic liver disease, or immunodeficiency syndrome, or if you’re pregnant or breastfeeding, talk with your doctor. DMARDs may not be the appropriate drugs for you.

Additional therapy/additional treatment options

If one conventional DMARD doesn’t work, you might want to try another one. Even though one may not be right, that doesn’t mean that another one won’t be effective. If it doesn’t work out, there are other medications besides conventional DMARDs that can be used to help treat AxSpA spectrum conditions. If you find that these drugs are not right for you, other treatments are available, including non-drug treatments like physical therapy and various lifestyle changes.

Talk with your doctor about the range of treatments available for your symptoms to fully address the symptoms you are experiencing.

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Written by: Jaime Rochelle Herndon | Last Reviewed: November 2020