By: Howard R. Smith, MD
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If you have recently been diagnosed with psoriatic arthritis, your doctor may have told you about a type of medicine that can reverse disease progression, stop damage to your joints – and might even put your disease into remission.
These medicines are called DMARDs, which stands for disease-modifying anti-rheumatic drugs. The drugs work by curbing the body’s out-of-control immune system response that causes psoriatic arthritis.
“DMARDs work by curbing your immune system, and, as a result, reduce inflammation,” says rheumatologist Howard R. Smith, MD.
Doctors often prescribe DMARDs when non-steroidal anti-inflammatories such as ibuprofen or other medications aren’t effective or for patients who have disease that is eroding their joints, Dr. Smith says.
DMARDs fall into two categories, biologic and non-biologic:
Non-biologic DMARDs – These medicines slow the disease process by modifying the immune system. Methotrexate is the most commonly prescribed non-biologic DMARD for psoriatic arthritis treatment. Methotrexate is an effective immune system suppressor and can treat the accompanying psoriasis as well as arthritis.
Biologic DMARDs – Introduced in the late 1990s for treating moderate to severe autoimmune diseases, biologic DMARDS target cells at a molecular level to prevent inflammation at a very early stage. They work by blocking a protein made by the immune system that contributes to psoriasis and arthritis. Biologic DMARDs are given by an injection or infusion into a blood vessel.
Reducing signs and symptoms
Both of these drugs reduce the signs and symptoms of psoriatic arthritis – and most exciting – they also can slow down damage to your joints, Dr. Smith says
“DMARDs slow down psoriatic arthritis and improve quality of life for most people,” Dr. Smith says. “Some patients will even achieve a remission while taking them. But more typically, disease activity continues, but at a slower, less intense rate.”
If your doctor prescribes DMARDs, here, according to Dr. Smith, are three things you should know about these powerful medicines.
1. All DMARDs may have side effects
Because DMARDs are a systemic treatment, they may have side effects, such as stomach upset, liver problems or blood issues, Dr. Smith says. It may take some tinkering for your physician to find the right regimen for you.
Possible long-term complications include liver damage with methotrexate and leflunomide. Some dormant long-term infections such as tuberculosis, can be re-activated by DMARDs.
“DMARDs change your immune system, so you may get more intense viral or bacterial infections. Make sure to let your doctor know about any serious infections,” Dr. Smith says.
You also should check with your doctor before getting any vaccines, Dr. Smith says. “Live vaccines, like the shingles vaccine, may be dangerous with certain of medications,” he says.
Some biologics also have been linked to a very small increased risk of cancer. You should ask your doctor about it, Dr. Smith says.
“Though DMARDs may have side effects, there still is good reason to take them — they’re proven to be effective against psoriatic arthritis,” Dr. Smith says.
2. It may take some time for DMARDs to work
It takes time for a DMARD to change your immune system. It may take months for some of the non-biologics to work. Biologic DMARDs may take a few weeks.
3. You may need to take more than one drug
DMARDs are used alone and in combination with other drugs. It’s also common for a physician to prescribe more than one DMARD. For example, studies show that methotrexate and a biologic may work better together than alone.