EDU: Medications - DMARD's

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You can find a list of generic and brand name DMARDs listed at this Stills

Disease Yahoo Group files. The file also included the phone numbers and web site

information along with the manufacturer. I use the list of generics and Brand

Name drugs to match the drugs my insurance will cover. I use the contact

information for Patient in Need assistance or for questions if I experience

unusual side effects. The list of DMARDs is about 3/4 of the way down the list

of commonly used arthritis medications. Here is the link.

http://f4.grp.yahoofs.com/v1/8F64Q0ImQffLJ9JhisUjzi_XOC0WuUYRJfo7Y2F-LIuEsurskVu\

keobAEOu6c1fp3gbkwtFaJEQmaD1HZqO7RvYMxX69jYIcu-g/MEDICATION%20HANDBOOK.doc

The following information is from Disease Modifying Antirheumatic Drugs

(DMARDs) (UpToDate) located on the http://search.nlm.nih.gov/medlineplus/ web

link. For more information on any of the specific drugs or about drug types,

please visit the above link.

WHAT ARE DISEASE MODIFYING ANTIRHEUMATIC DRUGS? — The term DMARD refers to a

number of medications that have been found to reduce signs and symptoms, reduce

or prevent joint damage and preserve the structure and function of the joints in

patients with RA. Their use is also credited with reducing health costs for

patients with RA and allowing them to remain active and productive. The most

common DMARDs in current use are: methotrexate (Rheumatrex®), sulfasalazine

(Azulfidine®), hydroxychloroquine (Plaquenil®), leflunomide (Arava®) and

cyclosporine (Sandimmune®, Neoral®). Others include gold salts (Solganal®),

azathioprine (Imuran®), and D-penicillamine (Cuprimine®, Depen®).

HOW DO DMARDs WORK? — Although not members of a single drug family, the DMARDs

all suppress the body's overactive immune and/or inflammatory systems in some

way, thereby controlling an aspect of the disease process.

WHEN ARE DMARD MEDICATIONS GIVEN? — Doctors now believe that all but the most

mild cases of RA should be treated with some form of DMARD medication. The ideal

time to begin the drugs is within three months of the onset of RA. This is

because joint damage, which ultimately may result in disability, begins early in

the course of RA. The goal of treatment with DMARDs is to prevent as much of

this damage as possible, simultaneously with reducing pain and stiffness, and

maintaining physical mobility. Complete remission of arthritis may occur during

DMARD therapy. Disease often recurs if DMARDs are stopped, leading some doctors

to recommend continued use of these drugs even if remission is achieved.

WHAT ARE THE RISKS AND SIDE EFFECTS OF DMARDs? — These medicines have known

toxicities; some are mild, others more serious. Actual side effects vary with

each medicine. Many will increase susceptibility to infection. Some cause hair

loss, some carry a risk of suppressing blood cell formation in bone marrow, or

causing kidney or liver damage, and the use of certain DMARDs may be associated

with a small increased risk of certain kinds of cancer. In prescribing DMARDs,

doctors weigh the risk of toxicities of various agents against the potential

benefit of the medication. Details about these aspects of treatment are

discussed with the patient, whose preferences will help guide the choice of

medication that will be prescribed. Doctors are careful to monitor potential

problem areas through blood tests and other methods, and can often decrease

doses or change medications if problems arise. In some cases, additional

medicines can be given to counter or prevent a particular toxicity or side

effect.

WHAT CAN I EXPECT FROM DMARD THERAPY? — DMARDs are also called slow-acting

antirheumatic drugs. They exert their effects over weeks or months and are not

designed to provide immediate relief of symptoms. Other medicines, such as pain

relievers, nonsteroidal antiinflammatory drugs (eg, ibuprofen or naproxen), and,

sometimes, prednisone are used as needed to help manage ongoing symptoms,

although effective DMARDs may allow a reduction in their use.

WHERE TO GET MORE INFORMATION — Your doctor is the best resource for finding

out important information related to your particular case. Not all patients are

alike, and it is important that your situation is evaluated by someone who knows

you as a whole person.

Patient Level Information:

Clinical manifestations and diagnosis of rheumatoid arthritis

New and alternative (complementary) therapies for rheumatoid arthritis

Side effects of sulfasalazine and the 5-aminosalicylates

Treatment of rheumatoid arthritis

What is arthritis?

Professional Level Information:

Overview of the management of rheumatoid arthritis

Anticytokine therapies in rheumatoid arthritis

Leflunomide in the treatment of rheumatoid arthritis

Novel and investigational therapies in rheumatoid arthritis other than

anticytokine therapy

Pharmacology of penicillamine and its use in rheumatoid arthritis

Rheumatoid arthritis and pregnancy

Sulfasalazine in the treatment of rheumatoid arthritis

T cell targeted therapies in the treatment of rheumatoid arthritis

Use of corticosteroids in the treatment of rheumatoid arthritis

Use of methotrexate in the treatment of rheumatoid arthritis

Clinical trials of combination DMARD therapy for rheumatoid arthritis

(Beautiful Southern Oregon, USA)

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May you have enough happiness to make you kind, enough trials to make you

strong, enough sorrow to keep you human, enough hope to make you happy.

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