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Arthritis: Disease-Modifying Medications

There are a variety of arthritis medications called disease-modifying antirheumatic drugs, or DMARDs, that work by curbing the underlying processes that cause certain forms of inflammatory arthritis including rheumatoid arthritis (RA), ankylosing spondylitis, and psoriatic arthritis.

These drugs not only treat arthritis symptoms, but they also can slow down progressive joint destruction. Some of these medications have been used to treat other conditions, such as cancer or inflammatory bowel disease, or to reduce the risk of rejection of a transplanted organ.

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DMARDs include:

  • Hydroxychloroquine (Plaquenil)
  • Leflunomide (Arava)
  • Cyclosporine (Neoral)
  • Sulfasalazine (Azulfidine)
  • Methotrexate (Rheumatrex, Trexall)
  • Azathioprine (Imuran)
  • Cyclophosphamide (Cytoxan)
  • Biologics (Actemra, Cimzia, Enbrel, Humira, Kineret, Orencia, Remicade, Rituxan, Simponi)
  • Tofacitinib (Xeljanz)


Anti-malarial Drugs (Plaquenil)

Plaquenil (hydroxychloroquine) is a drug used to treat malaria. It was discovered that it worked for arthritis when people taking the drug for malaria reported improvements in their arthritis. The drug affects the immune system, although doctors do not know precisely how it works to improve rheumatoid conditions.

Usually Plaquenil is used along with other DMARDs. It can be given along with steroid treatment. Plaquenil is also used to treat the lupus.

Plaquenil is given by mouth daily. Side effects include low white blood cell counts, blood or protein in the urine, nausea, and skin rashes. High doses can rarely cause injury to the back of the eye (retina); therefore, patients on this drug should see an eye doctor every 12 months.


Arava (leflunomide) helps calm the inflammation associated with RA. Arava interferes with the production of inflammatory cells, like those of the immune system. It can reduce signs and symptoms of RA, inhibit joint damage, and can also improve physical function.

Arava is a tablet that is taken in a dose of 10 or 20 milligrams once a day. Arava can be taken on an empty stomach or with meals. Possible side effects include rash, hair loss, irritation of the liver, nausea, diarrhea, and abdominal pain. When taking Arava, it is necessary to have regular blood tests to check liver function and other measures. Arava is not recommended for people who have liver disease, pregnant or nursing women, or people with immune systems weakened by an immune deficiency or disorder.

Since Arava can cause serious birth defects, both men and women should use a reliable method of birth control while being treated with this drug. If a woman taking Arava wishes to become pregnant, she must stop Arava. Then she must follow a drug elimination procedure to get all the Arava out of the body, and then have a blood test to prove that the drug is cleared. Less is known about the effects of Arava on men planning to father children. Men should consider stopping Arava and following the drug elimination procedure before attempting to conceive.

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