Disease-modifying anti-rheumatic drugs (DMARDs)

Disease-modifying anti-rheumatic drugs (DMARDs) can treat the underlying cause of your condition and reduce inflammation. They're given to people with autoimmune conditions, such as rheumatoid arthritis, psoriatic arthritis and lupus. These are conditions where the immune system, which normally fights infection, attacks the body’s own healthy tissues.

DMARDs can improve symptoms such as pain, stiffness and swelling, but they may take a few weeks or even months to fully take effect.

There are different types of DMARDs, and they work in slightly different ways. The three main types are:

• conventional synthetic DMARDs, including methotrexate
• biological therapies, like adalimumab
• targeted synthetic DMARDs, such as the JAK inhibitors baricitinib and tofacitinib.

Conventional DMARDs

This group of drugs are slow-acting and can take several weeks to work, so it's important to keep taking them even if they don't seem to have any effect at first. If you don't respond well to one of these drugs, or if you develop any side-effects, then your doctor may try one of the others.

Read more about the following conventional DMARDs:

• apremilast
• azathioprine
• ciclosporin
• cyclophosphamide
• hydroxychloroquine
• leflunomide
• methotrexate
• mycophenolate
• sulfasalazine.

Biological therapies

Biological therapies are a relatively new class of medicines. They stop or block particular cells in the immune system from triggering inflammation, and so target the underlying cause of diseases. They tend to work more quickly than conventional DMARDs.

Some biological therapies are called anti-TNF drugs. They target a protein called tumour necrosis factor, which increases inflammation when excess amounts are present in the blood or joints. Other biological therapies target different proteins.

Biological therapies are only given to people who have already tried other treatments appropriate to their condition and not responded well to them. Biological therapies are often given in combination with a conventional DMARD such as methotrexate.

Read more about the following biological therapies:

• abatacept
• belimumab
• ixekizumab
• rituximab
• sarilumab
• secukinumab
• tocilizumab
• ustekinumab.

Read more about the following anti-TNF drugs:

• adalimumab
• certolizumab pegol
• etanercept
• golimumab
• infliximab.

JAK inhibitors

JAK inhibitors are a class of drugs that work by blocking the action of Janus kinase enzymes, which are involved in the inflammation that causes the symptoms of rheumatoid arthritis and psoriatic arthritis.

Read more about the following JAK inhibitors:

• baricitinib
• tofacitinib.