Disease-Modifying Antirheumatic Drugs (DMARDs)

Disease-Modifying Antirheumatic Drugs (DMARDs) are drugs that inhibit the immune response in medical conditions such as rheumatoid arthritis, psoriatic arthritis, and Immune thrombocytopenic purpura (ITP).

Disease-Modifying Antirheumatic Drugs (DMARDs) are medications that may be prescribed for back pain symptoms caused by systemic diseases such as rheumatoid arthritis. Rheumatoid arthritis is a systemic disease that causes the body to attack it's own joints and cause inflammation to those areas. DMARDs are a group of medications that are more specific the effects of rheumatoid arthritis, unlike non-steroidal anti-inflammatory medications (NSAIDs) and steroids. Both NSAIDs and steroids work to inhibit the inflammatory process but do not address the cause of the condition of rheumatoid arthritis. Disease-Modifying Antirheumatic Drugs treat several other medical conditions, in addition to rheumatoid arthritis, including:
  • Ulcerative colitis (inflammation of the colon)
  • Myasthenia gravis (an autoimmune neuromuscular disease which causes fatigue and muscular weakness)
  • Immune thrombocytopenic purpura (ITP) (an immune system disease that results in a low platelet count in the blood)
  • Lupus erythematosus (an autoimmune disease that causes the impairment of the joints as well as multiple organ systems)
  • Crohn's Disease (an inflammatory bowel disease that may cause pain or discomfort along any section of the digestive (GI) tract)


Doctors and researchers are still learning the connections between these various diseases, and why the DMARDs treatments work against them. Most of the diseases listed above are autoimmune diseases, but ulcerative colitis is not considered to be an autoimmune disease. this group of about 20 medications are grouped according to their ability towards inhibiting the effects of each of these diseases, even though their mechanisms of action upon the cells, tissues, and organs vary. Antiofoliate: The drug methotrexate (MTX) inhibits the body's production of folic acid, which may reduce organ rejection in transplant patients and the inflammatory response in patients with joint pain and back pain. TNF inhibition: TNF, or tumor necrosis factor initiates the inflammatory response in our bodies in response to an injury, arthritic condition or autoimmune diseases such as psoriasis and ankylosing spondylitis. The DMARD drugs that specifically inhibit TNF include:
  • adalimumab
  • (antimalarials) hydroxychloroquine and chloroquine
  • etanercept
  • golimumab
  • infliximab
  • sulfasalazine (SSZ)
Purine synthesis inhibitor: The initiation of the inflammatory process includes the flood of red blood cells and white blood cells to the joints targeted for inflammation. Purine synthesis inhibitor specifically target the proliferation of leukocytes, which are the white blood cells. Disease-Modifying Antirheumatic Drugs which inhibit purine synthesis include azathioprine.

Pyrimidine synthesis inhibitor: The medication leflunomide treats psoriatic and rheumatoid arthritis by inhibiting the mitochondrial enzyme dihydroorotate dehydrogenase, which is involved in the activation of lymphocytes and immune system response. Calcineurin inhibitor: The medication ciclosporin (Cyclosporin A) inhibits lymphokine production and interleukin release, which are intermediate chemical processes towards the ultimate production of T-lymphocytes. T Cells are white blood cells that are involved in the process of inflammation. Cyclosporin A inhibits the inflammatory process, and is prescribed for medical conditions such as atopic dermatitis, psoriasis, and rheumatoid arthritis.

T-lymphocyte inhibitor: The medication D-penicillamine inhibits T-lymphocytes, which are involved in the body attacking joint tissues in autoimmune conditions.