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

6 thoughts on “DMARDS in the treatment of rheumatoid arthritis

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

  2. 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

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

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

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