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Pain Management Health Center

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Give DMARDs Time

Most people start a disease modifying antirheumatic drug (DMARD), such as methotrexate, soon after RA diagnosis. If you're still adjusting to a DMARD or want to better understand how it slows joint damage, take a few days to learn more.

Do I Need a DMARD?

Wonder why your doctor prescribed methotrexate or another DMARD -- disease modifying anti-rheumatic drug? Do you really need it, especially if your symptoms aren't so bad? The answer is yes. RA is sneaky -- it attacks joints before you may know it. By the time symptoms really bother you, the damage may be serious and irreversible. DMARDs can slow or stop joint damage, sparing you serious problems later. Talk with your doctor about any concerns you have so you'll feel more comfortable.

DMARD Options

When you were diagnosed with RA, your doctor likely prescribed methotrexate, the most commonly used DMARD for RA. Your doctor may prescribe other DMARDs in addition to or instead of methotrexate. Such combinations may work better than a single DMARD alone.

Other DMARDs include meds such as Arava (leflunomide), Azulfidine (sulfasalazine), Azasan or Imuran (azathioprine), cyclosporine, and Plaquenil (hydroxychloroquine). Ask your doctor to explain how he or she picked DMARDs for you.

Tip CTA: More than methotrexate?

How DMARDs Work

DMARDs target RA's root cause -- an overactive immune system that attacks your body. DMARDs suppress your immune system and protect joints and tissue from damage. They can change RA's course, slowing or stopping the disease. That makes DMARDs distinct from many RA meds, such as NSAIDs or acetaminophen, which just treat symptoms such as pain and swelling.

DMARDs also decrease pain and inflammation. Still, it's not uncommon for you to sometimes need another med to ease pain.

Combination Therapy

Often, the best approach to prevent long-term disability may not be just a DMARD. Many people take more than one DMARD. Others take a DMARD along with a steroid or with a biologic. Biologics target specific substances in the body to help manage the out-of-control immune reaction. To learn more about biologics, browse Med Goals. Even triple combos of meds are common.

Infection Risk

DMARDs work by suppressing your immune system. That reduces the damage from RA, but it also increases your risk of infections. The risk varies from drug to drug. What's more, the benefits of DMARDs in stopping joint damage -- and improving your quality of life -- often outweigh the risks. Talk with your doctor. Ask for help putting the risks of DMARDs in perspective with their benefits specifically to you.

Give DMARDs Time

If you started DMARD treatment within the last few weeks, you may be wondering, "Shouldn't I feel better by now?" A delayed effect is normal, however.

Unlike NSAIDs and steroids, DMARDs don't give immediate relief from pain and inflammation. With most, you need weeks -- or even months -- before you feel all the benefits. If several months have gone by and you still don't feel any better, talk with your doctor.

Get Checkups

When you take a DMARD, your doctor will want to do regular testing to ensure treatment isn't causing unseen problems -- and to test its benefits.

Ask your doctor how often you'll need checkups. Frequency depends on the meds. People taking methotrexate, for example, usually need testing every 4 to 12 weeks to check their blood counts and their kidney and liver functions. Tests to evaluate effectiveness may include inflammation level tests, X-rays, and assessment of your ability to function.

Tip CTA: Test DMARD effectiveness.

DMARDs and Vaccines

Because DMARDs increase your risk of infections, your doctor may recommend that you get some vaccines before you start taking a DMARD. Live vaccines are avoided when using biologics. You and your doctor need to make sure that your vaccines are up-to-date. Getting a pneumococcal vaccine and an annual flu vaccine are especially important. 

DMARDs and Alcohol

Methotrexate and other DMARDs can affect the liver. While you probably won't have serious problems, your doctor may suggest that you stop drinking alcohol completely when you first start a DMARD.

If your liver tests are OK at your checkups, you can ask your doctor if it's safe for you to have an occasional glass of alcohol.

Be sure to follow your doctor's suggestions. Drinking more than recommended could lead to liver damage.

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