Traditional DMARDs for Psoriatic Arthritis
Reviewed by: HU Medical Review Board | Last reviewed: June 2022 | Last updated: December 2022
One common treatment for psoriatic arthritis (PsA) is disease-modifying anti-rheumatic drugs (DMARDs). There are different types of DMARDs. These include traditional (or non-biologic), biologic, and target-specific DMARDs. DMARDs reduce inflammation. They can also help prevent long-term joint damage, which can cause disability. This is why they are called “disease-modifying” – they can interrupt the processes that cause joint damage in psoriatic arthritis.
Newer DMARDs, like biologics and target-specific DMARDs, impact specific steps in the pathway to inflammation. While traditional DMARDs also affect the immune system and inflammatory response, they are much broader in action.1-3
How do traditional DMARDs work?
Each type of traditional DMARD works in a different way. Some block the action of white blood cells. Others decrease cytokine production (chemical messengers that lead to inflammation) or protect cells from damage. Regardless of the exact properties of each DMARD, they all serve the same purpose: to slow down the immune response. This can lead to lower levels of inflammation in the body and an improvement in PsA symptoms.1-3
Examples of traditional DMARDs for PsA
A variety of different traditional DMARDs exist for PsA. Several of these are:1-3
- Methotrexate (sold under a variety of brand names including Trexall™ and Otrexup®)
- Azulfidine® (sulfasalazine)
- Arava® (leflunomide)
- Antimalarial drugs (including hydroxychloroquine and chloroquine phosphate)
What are the possible side effects of traditional DMARDs?
Side effects can vary depending on the DMARD you are taking. Some of the most common side effects include:4-7
- Painful ulcers in the mouth
- Abdominal discomfort
- Nausea, vomiting, and decreased appetite
- Low levels of white blood cells
- Respiratory infections
- Changes in labs measuring liver function
These are not all the possible side effects of traditional DMARDs. Talk to your doctor about what to expect or if you experience any changes that concern you during treatment.
Things to know about traditional DMARDs
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, talk with your doctor immediately. Some traditional DMARDs can impact fertility and harm an unborn or breastfeeding baby.
In some cases, traditional DMARDs may impact your blood cell counts or increase your 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.
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, since many traditional DMARDs can interact with other drugs.
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.
Traditional DMARDs can also impact a person’s ability to safely receive live vaccines. However, most vaccines are not live and can still be taken. Talk with your doctor before starting a traditional DMARD if you recently received or will soon receive a vaccine.4-7