June 15, 2024
Pharmacology Presentations

DMARDS in the treatment of rheumatoid arthritis

  • July 2, 2010
  • 3 min read
DMARDS in the treatment of rheumatoid arthritis

Presentation on Present status of DMARDS in the treatment of RA

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  • To highlight the present status of disease modifying anti-rheumatic drugs (DMARDs) in the treatment of rheumatoid arthritis


  • DMARDs (disease modifying antirheumatic drugs) are drugs which can suppress the rheumatoid process and bring about a remission, but do not have nonspecific anti-inflammatory or analgesic action.

Classification of Anti-rheumatic drugs


  • Immunosuppressants: Methotrexate, Cyclosporine, Azathioprine
  • Sulfasalazine
  • Chloroquine or hydroxychloroquine
  • Leflunomide
  • Gold salts
  • d-Penicillamine

B. Biological response modifiers(BRMs):

  • TNF-α inhibitors: Etanercept, Infliximab
  • IL-1 antagonist: Anakinra

C. Adjuvant drugs

  • Corticosteroids: Prednisolone



  • First choice and standard drug for rheumatoid arthritis.
  • Acts by inhibiting an enzyme dihydrofolate reductase
  • Also inhibits other enzyme involve in protein synthesis as well as anti-inflammatory and cytokines modulating effect.
  • Initially low dose(7.5-15 mg/week)
  • Best tolerated among other DMARDs

Adverse drug effects

  1. Nausea and mouth ulcer
  2. Pancytopenia (low blood cells)
  3. Liver cirrhosis
  4. Acute pneumonitis

• Pregnancy
• Lactating mother
• Liver disease
• Leucopenia
• Peptic ulcer


  • It is a compound of sulfapyridine and 5-amino salicyclic acid (5-ASA)
  • Useful in both RA and ulcerative colitis
  • Much more safer than gold salts
  • Second line drugs for milder cases
  • Mode of action is unknown

Adverse drug effects:

  1. Neutropenia, hemolytic anemia
  2. Thrombocytopenia

Gold Salts

  • Water soluble gold preparation like sodium aurothiomalate
  • Gets deposited in the synovial macrophages in actively inflammed joints and inhibits their function.

Adverse drug effects:

  • Dermatitis, nephropathy, bone marrow depression and liver damage.


  • It is a recombinant fusion protein of TNF-receptor and Fc portion of human IgG
  • Reserved for the patients who have failed to respond to adequate trials of atleast two DMARDs

Adverse drug reaction:

  1. Pain, redness, itching, swelling at the infection site
  2. Chest infection may be increasedd-Penicillamine
  3. Splits the rheumatoid factor and also selectively reduces the serum levels of calcium immunoglobin
  4. Adverse drug reactions incidences are high so not commonly used

Gold salts and d-penicillamine should not be combined for the treatment of RA (because of severe ADRs). Gold salts and d-penicillamine are not used in the present context because of severe adverse reactions i.e.

  • Bone marrow depression
  • Kidney and liver damage
  • Ulceration

Presented by Students of KistMCTH 1st year students

  1. Hemu Chaurasia(Roll no-36)
  2. Jemesh Singh Maharjan (Roll no-37)
  3. Jeni Thapa(Roll no-38)
  4. Keshav KC (Roll no-39)
  5. Manisha Bohara (Roll no-40)
  6. Manisha Dhakal (Roll no-41)
  7. Manisha Maharjan (Roll no-42)


  1. Text book of Pharmacology- K D Tripathi
  2. Text book of Pharmacology- Bennett and Brown
About Author



  • A mnemonic to remember DMARDs:
    C : Cyclosporine
    H : Hydroxychloroquine/Chloroquine
    A : Auranofin
    M : Methotrexate
    P : d-Penicillamine

    • An easy way through..
      thank you ..
      will be helpful for me..

  • You are welcome, Chris. I am glad that I could make your job easy. Hope for the same in near future as well.

  • Thank you for this wonderful presentation. You made my job easy.

  • Thank you Gabriella Boydstun, yes I hope these posts will be benefitial to all the people, whether they’re engaged in medical field or not.
    You are more than welcome to bookmark this site.
    Thank You

  • Of course, what a great site and informative posts, I will add backlink – bookmark this site? Regards, Reader

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