DMARDs (Disease-Modifying Anti Rheumatic Drugs); Types

Last updated: February 7, 2026Reviewed date: February 7, 2026Reading time: 5 min read
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DMARDs (Disease-modifying antirheumatic drugs ) is a category of otherwise unrelated drugs defined by their use in rheumatoid arthritis to slow down disease progression. The term is often used in contrast to nonsteroidal anti-inflammatory drug (which refers to agents that treat the inflammation but not the underlying cause) and steroids (which blunt the immune...

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Article Summary

DMARDs (Disease-modifying antirheumatic drugs ) is a category of otherwise unrelated drugs defined by their use in rheumatoid arthritis to slow down disease progression. The term is often used in contrast to nonsteroidal anti-inflammatory drug (which refers to agents that treat the inflammation but not the underlying cause) and steroids (which blunt the immune response but are insufficient to slow down the progression of the disease). The term "antirheumatic" can be used in similar...

Key Takeaways

  • This article explains Types of DMARDs in simple medical language.
  • This article explains Mechanism of Action of DMARDs in simple medical language.
  • This article explains Contraindications of DMARDs  in simple medical language.
  • This article explains Monitoring in simple medical language.
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Definition

DMARDs (Disease-modifying antirheumatic drugs ) is a category of otherwise unrelated drugs defined by their use in pain, swelling, stiffness, or reduced movement. সহজ বাংলা: জয়েন্টের প্রদাহ।" data-rx-term="arthritis" data-rx-definition="Arthritis means joint inflammation causing pain, swelling, stiffness, or reduced movement. সহজ বাংলা: জয়েন্টের প্রদাহ।">arthritis: Rheumatoid arthritis is an autoimmune joint disease causing infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।" data-rx-term="inflammation" data-rx-definition="Inflammation is the body’s response to injury, infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।">inflammation, pain, and swelling. সহজ বাংলা: রোগপ্রতিরোধ ব্যবস্থার ভুল আক্রমণে জয়েন্টের প্রদাহ।" data-rx-term="rheumatoid arthritis" data-rx-definition="Rheumatoid arthritis is an autoimmune joint disease causing inflammation, pain, and swelling. সহজ বাংলা: রোগপ্রতিরোধ ব্যবস্থার ভুল আক্রমণে জয়েন্টের প্রদাহ।">rheumatoid arthritis to slow down disease progression. The term is often used in contrast to nonsteroidal infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।" data-rx-term="inflammation" data-rx-definition="Inflammation is the body’s response to injury, infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।">inflammation, pain, or swelling. সহজ বাংলা: প্রদাহ/ফোলা/ব্যথা কমায়।" data-rx-term="anti-inflammatory" data-rx-definition="Anti-inflammatory means reducing inflammation, pain, or swelling. সহজ বাংলা: প্রদাহ/ফোলা/ব্যথা কমায়।">anti-inflammatory drug (which refers to agents that treat the inflammation but not the underlying cause) and steroids (which blunt the immune response but are insufficient to slow down the progression of the disease).

The term “antirheumatic” can be used in similar contexts, but without making a claim about an effect on the course. Other terms that have historically been used to refer to the same group of drugs are “remission-inducing drugs” (RIDs) and “slow-acting anti-rheumatic drugs” (SAARDs).

Types of DMARDs

DMARDs have been classified as

Synthetic (sDMARD)

Conventional synthetic and targeted synthetic DMARDs (csDMARDs and tsDMARDs, respectively)

  • csDMARDs are the traditional drugs (such as methotrexate, sulfasalazine, leflunomide, hydroxychloroquine, gold salts)
  • tsDMARDs are drugs that were developed to target a particular molecular structureB

Biological (bDMARD)

These can be further separated into original and biosimilar DMARDs (boDMARDs and bsDMARDs)

  • bsDMARDs are those that have the same primary, secondary and tertiary structure as an original (boDMARD) and possess similar efficacy and safety as the original protein
Drug Mechanism Type
abatacept T-cell costimulatory signal inhibitor bDMARD
adalimumab TNF inhibitor bDMARD
anakinra IL-1 receptor antagonist bDMARD
azathioprine Purine synthesis inhibitor unknown
chloroquine (anti-malarial) Suppression of IL-1, induce apoptosis of inflammatory cells and decrease chemotaxis unknown
ciclosporin (Cyclosporin A) calcineurin inhibitor unknown
D-penicillamine (seldom used today) Reducing numbers of T-lymphocytes etc. unknown
etanercept decoy TNF receptor bDMARD
golimumab TNF inhibitor bDMARD
gold salts (sodium aurothiomalate, auranofin) (seldom used today) unknown csDMARD
hydroxychloroquine (anti-malarial) TNF-alpha, induce apoptosis of inflammatory cells and decrease chemotaxis csDMARD
infliximab TNF inhibitor bDMARD
leflunomide Pyrimidine synthesis inhibitor csDMARD
methotrexate (MTX) Purine metabolism inhibitor csDMARD
minocycline 5-LO inhibitor unknown
rituximab chimeric monoclonal antibody against CD20 on B-cell surface bDMARD
sulfasalazine (SSZ) Suppression of IL-1 & TNF-alpha, induce apoptosis of inflammatory cells and increase chemotactic factors csDMARD
tocilizumab IL-6 receptor antagonist bDMARD
tofacitinib kinase inhibitor tsDMARD

Traditional DMARDs

  • Azathioprine (Azasan, Imuran, generic): Comes in tablet only; used most commonly in lupus. This drug depends on a specific enzyme to work and some people lack enough of this enzyme to make the drug effective. Your doctor will test your levels before prescribing azathioprine.
  • Cyclophosphamide (generic only): Comes in capsule, tablet or infusion. Can be used in lupus in patients who do not respond to traditional therapy or who experience kidney damage.
  • Cyclosporine (Neoral, Gengraf, Sandimmune, generic): Comes in capsule or syrup. This medicine is used sometimes for lupus in people who do not respond to other therapies.
  • Hydroxychloroquine sulfate (Plaquenil, generic): Comes in tablet only. Antimalarial drugs are commonly used to treat pain, swelling, stiffness, or reduced movement. সহজ বাংলা: জয়েন্টের প্রদাহ।" data-rx-term="arthritis" data-rx-definition="Arthritis means joint inflammation causing pain, swelling, stiffness, or reduced movement. সহজ বাংলা: জয়েন্টের প্রদাহ।">arthritis: Rheumatoid arthritis is an autoimmune joint disease causing infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।" data-rx-term="inflammation" data-rx-definition="Inflammation is the body’s response to injury, infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।">inflammation, pain, and swelling. সহজ বাংলা: রোগপ্রতিরোধ ব্যবস্থার ভুল আক্রমণে জয়েন্টের প্রদাহ।" data-rx-term="rheumatoid arthritis" data-rx-definition="Rheumatoid arthritis is an autoimmune joint disease causing inflammation, pain, and swelling. সহজ বাংলা: রোগপ্রতিরোধ ব্যবস্থার ভুল আক্রমণে জয়েন্টের প্রদাহ।">rheumatoid arthritis and can help improve the skin lesions of lupus, and can hold off disease recurrence and prevent organ damage.  Serious side effects for antimalarial drugs are rare.
  • Leflunomide (Arava, generic): Comes as a pill taken once a day. People who cannot tolerate methotrexate may take leflunomide. It can also be taken in combination with methotrexate.
  • Methotrexate (Rheumatrex, Trexall, Otrexup, Rasuvo, generic): This drug is taken once a week and comes in tablet or as a self-injectable. It is for adults with active RA and children with active juvenile idiopathic pain, swelling, stiffness, or reduced movement. সহজ বাংলা: জয়েন্টের প্রদাহ।" data-rx-term="arthritis" data-rx-definition="Arthritis means joint inflammation causing pain, swelling, stiffness, or reduced movement. সহজ বাংলা: জয়েন্টের প্রদাহ।">arthritis with more than one affected joint.
  • Mycophenolate mofetil (CellCept, generic): Comes in tablet, capsule and as a self-injectable. This drug may be used in people whose RA does not respond to other therapies.
  • Sulfasalazine (Azulfidine, Sulfazine, generic): Comes in regular or extended-release tablets. This drug is most commonly used in a triple therapy combination for RA (methotrexate, sulfasalazine, hydroxychloroquine).

Mechanism of Action of DMARDs

The class of DMARDs is extensive, and traditional DMARDs act via various mechanisms. They interfere in combinations of critical pathways in the inflammatory cascade. Methotrexate, for example, stimulates adenosine release from fibroblasts, reduces bacterial infection. সহজ বাংলা: ব্যাকটেরিয়ার বিরুদ্ধে লড়াই করা শ্বেত রক্তকণিকা।" data-rx-term="neutrophil" data-rx-definition="Neutrophil is a white blood cell important for fighting bacterial infection. সহজ বাংলা: ব্যাকটেরিয়ার বিরুদ্ধে লড়াই করা শ্বেত রক্তকণিকা।">neutrophil adhesion, inhibits leukotriene B4 synthesis by neutrophils, inhibits local IL-1 production, reduces levels of IL-6 and IL-8, suppresses cell-mediated immunity, and inhibits synovial collagenase gene expression. Other medications in this class serve to inhibit proliferation or cause dysfunction of lymphocytes.

Biologics, on the other hand, are very selective in their mechanism of action. The overarching functional of biologics include (1) interfering with cytokine function or production, (2) inhibiting the “second signal” required for T-cell activation, and (3) depleting B-cells or inhibiting factors that active B-cells (rituximab and belimumab). Tofacitinib is a small molecule inhibitor of JAK, a protein tyrosine kinase involved in mediating cytokine signaling.

Contraindications of DMARDs 

DMARDs are not to be taken by patients who have an active infection, those with preexisting bone marrow hypoplasia, leukopenia, chronic liver disease, or immunodeficiency syndromes. Methotrexate is contraindicated in pregnancy.

Monitoring

  • Most DMARDs which cause myelosuppression and hepatotoxicity can be monitored with a complete blood count (CBC) and liver function tests every 2 weeks to monthly.
  • Those that cause macular damage (hydroxychloroquine) should be monitored with funduscopic exams twice yearly.
  • Cyclophosphamide, which can cause hemorrhagic cystitis and bladder cancer, can be monitored with a CBC and urinalysis every 2 weeks.
  • Cyclosporine and FK506 (tacrolimus) can cause renal insufficiency, hypertension, and anemia and should be monitored with blood pressure and creatinine checks bi-monthly, along with periodic CBC, potassium levels, and liver enzymes.
  • Biologics including etanercept and infliximab can allow for systemic infection as well as injection site infection. They can be monitored with PPD before initiating or re-starting therapy as well as periodic CBC.

Referances

DMARDs (Disease-Modifying Anti Rheumatic Drugs); Types

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What to tell the doctor

  • Write when the problem started and how it changed.
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Questions to ask

  • What is the most likely cause of my symptoms?
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  • Do not delay emergency care when danger signs are present.

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Doctor to discuss: Doctor / qualified healthcare provider
Tests to discuss with doctor
  • Basic vital signs: temperature, pulse, blood pressure, oxygen level if needed
  • Relevant blood, urine, imaging, or specialist tests only after clinical assessment
Questions to ask
  • What is the most likely cause of my symptoms?
  • Which warning signs mean I should go to emergency care?
  • Which tests are really needed now?
  • Which medicines are safe for my age, pregnancy status, allergy, kidney/liver/stomach condition, and current medicines?

Emergency warning signs such as chest pain, severe breathing difficulty, sudden weakness, confusion, severe dehydration, major injury, or loss of bladder/bowel control need urgent medical care. Do not wait for online information.

Safe pathway to proper treatment

Care roadmap for: DMARDs (Disease-Modifying Anti Rheumatic Drugs); Types

Use this simple roadmap to understand the next safe steps. It is educational and does not replace examination by a doctor.

Go to emergency care if you notice:
  • Severe or rapidly worsening symptoms
  • Breathing difficulty, chest pain, fainting, confusion, severe weakness, major injury, or severe dehydration
Doctor / service to discuss: Qualified healthcare provider; specialist depends on symptoms and examination.
  1. Step 1

    Check danger signs first

    If danger signs are present, seek emergency care and do not wait for online information.

  2. Step 2

    Record the symptom story

    Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.

  3. Step 3

    Visit a qualified clinician

    A doctor, nurse, or qualified healthcare provider can examine you and decide which tests or treatment are needed.

  4. Step 4

    Do only useful tests

    Do tests after clinical assessment. Avoid unnecessary tests, random antibiotics, or repeated medicines without diagnosis.

  5. Step 5

    Follow up and return early if worse

    If symptoms worsen, new warning signs appear, or treatment is not helping, return for review quickly.

Rural patient practical tips
  • Take a written symptom diary and all previous prescriptions/test reports.
  • Do not hide medicines already taken, even herbal or over-the-counter medicines.
  • Ask which warning signs mean urgent referral to hospital.

This roadmap is for education. A real diagnosis and treatment plan requires history, examination, and clinical judgment.

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Frequently Asked Questions

Is this article a replacement for a doctor?

No. It is educational content only. Patients should consult a qualified clinician for diagnosis and treatment.

When should I seek urgent care?

Seek urgent care for severe symptoms, rapidly worsening condition, breathing difficulty, severe pain, neurological changes, or any emergency warning sign.

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