Traditional DMARDs for Psoriatic Arthritis

Reviewed by: HU Medical Review Board | Last reviewed: February 2024 | Last updated: February 2024

A common treatment for psoriatic arthritis (PsA) is disease-modifying antirheumatic drugs (DMARDs). There are different types of DMARDs, including traditional, biologic, and target-specific DMARDs. DMARDs reduce inflammation.1

Traditional DMARDs – also called conventional or non-biologic DMARDs – can also interrupt the processes in PsA that cause joint damage. This is why they are called “disease-modifying.” Long-term joint damage can lead to disability.1

Biologics and target-specific DMARDs are newer drugs than traditional DMARDs. While the newer drugs impact specific steps in the body’s inflammation process, traditional DMARDs are much broader in action.1-3

How do traditional DMARDs work?

Each type of traditional DMARD works differently. Some block the action of white blood cells. Others decrease the production of cytokines (chemical messengers that lead to inflammation) or protect cells from damage.1-3

However, all DMARDs serve the same purpose: to slow down the immune response. This can lead to lower levels of inflammation in the body and improved PsA symptoms.1-3

Examples of traditional DMARDs for PsA

A variety of traditional DMARDs are used to treat PsA. They include:1-3

  • Methotrexate (Trexall™, Otrexup®)
  • Azulfidine® (sulfasalazine)
  • Arava® (leflunomide)

What are the possible side effects?

Side effects can vary depending on the specific drug you are taking. The most common side effects of traditional DMARDs include:1,3

  • Mouth ulcers
  • Nausea, vomiting, and decreased appetite
  • Low levels of white blood cells
  • Headache
  • Rash
  • Diarrhea
  • Respiratory infections
  • Liver damage

Some traditional DMARDs, including methotrexate and sulfasalazine, have a boxed warning, the strictest warning from the US Food and Drug Administration (FDA). They have this warning because they can affect fertility and harm unborn or breastfeeding babies.1,4-6

These are not all the possible side effects of traditional DMARDs. Talk to your doctor about what to expect when taking traditional DMARDs. You also should call your doctor if you have any changes that concern you when taking traditional DMARDs.

Other things to know

Because they decrease inflammation and immune system response, traditional DMARDs can increase the risk of infection. Do not start taking a traditional DMARD if you have an active infection. If you develop fevers, chills, muscle aches, or other symptoms of an infection, tell your doctor immediately.1,4-6

In some cases, traditional DMARDs may impact blood cell counts or increase the risk of cancer. Also, certain traditional DMARDs may impact the nervous system, heart, liver, kidneys, and skin. These effects may be severe. Your doctor can tell you if your drug has any of these risks.4-6

Although it is rare, serious allergic reactions can occur with traditional DMARDs. Tell your doctor about any allergic reactions you have had to drugs in the past. Signs of an allergic reaction include hives, trouble breathing, abdominal pain, and swelling of the face, tongue, or lips.4-6

Some DMARDs can harm unborn babies or infants. Before taking a traditional DMARD, tell your doctor if you are pregnant, planning to become pregnant, or breastfeeding.4-6

Traditional DMARDs can also impact a person’s ability to safely receive live vaccines. Since most vaccines are not live, most can still be taken. But talk with your doctor before starting a traditional DMARD if you recently received or plan to receive a vaccine.4-6

Before beginning treatment for PsA, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.

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Treatment results and side effects can vary from person to person. This treatment information is not meant to replace professional medical advice. Talk to your doctor about what to expect before starting and while taking any treatment.