DMARDs: Disease-Modifying Antirheumatic Drugs
DMARDs stands for Disease-Modifying Antirheumatic Drugs 1.
Definition and Core Concept
Disease-Modifying Antirheumatic Drugs (DMARDs) are medications that modify the underlying disease process in inflammatory arthritis conditions, not just treating symptoms but actually slowing or halting disease progression and preventing joint damage 1, 2.
Classification System
DMARDs are categorized into three main classes based on their structure and mechanism 3:
Conventional Synthetic DMARDs (csDMARDs)
- Include methotrexate, sulfasalazine, hydroxychloroquine, leflunomide, and azathioprine 1, 3
- These are small molecule drugs that work through various mechanisms to suppress inflammation 2
Biologic DMARDs (bDMARDs)
- Protein-based drugs that target specific components of the immune system 3
- TNF inhibitors include adalimumab, etanercept, infliximab, golimumab, and certolizumab pegol 3, 2
- Other biologics target IL-1 receptor, IL-6 receptor, B lymphocytes (rituximab), and T-cell costimulation (abatacept) 3
Targeted Synthetic DMARDs (tsDMARDs)
- Small molecule drugs that work intracellularly, primarily Janus kinase (JAK) inhibitors 1, 3
- Include tofacitinib, baricitinib, and upadacitinib 1
- Block intracellular signaling pathways involved in inflammation 3
Clinical Applications
DMARDs are the cornerstone of treatment for rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, juvenile idiopathic arthritis, and systemic lupus erythematosus 1, 2.