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Track DMARD Effects

Medically Reviewed by Sabrina Felson, MD on January 19, 2021

Track DMARD Effects

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DMARDs are often standard treatment for rheumatoid arthritis. Even if you've been taking them a while, you still need to track how well they work and watch for side effects. Set aside time to review what to expect from DMARD treatment and the precautions you need to take.

Conditions: Rheumatoid arthritis

Symptoms: loss of appetite, fatigue, feeling sick, symptoms worse in A.M., weakness, fever, lumps under skin, reduced joint movement, stiffness, stiffness after rest, anxiety, depression, deformed joint, stiff joint, swollen joint, warm joint, joint pain, muscle pain, pain, lower back pain, upper back pain, symmetrical pain, numbness, tingling, aching, burning, finger pain, elbow pain, knee pain, spinal pain, wrist pain, hand pain

Triggers:

Treatments:auranofin (Ridaura), azathioprine (Azasan, Imuran), chlorambucil (Leukeran), cyclophosphamide, cyclosporine (GengrafNeoral), hydroxychloroquine (Plaquenil), leflunomide (Arava), methotrexate (Rheumatrex), minocycline (Minocin), mycophenolate mofetil (CellCept), myochrysine, sulfasalazine (Azulfidine)

Categories: Treatment

Duration

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14    

Folic Acid Help

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Folic acid may also help with many of the other common side effects from methotrexate, such as fatigue, headaches, hair loss, and oral ulcers. Ask your doctor if folic acid might help you -- don't just start taking it on your own. Many people using this DMARD take daily folic acid supplements. Some people may take a prescription form of folic acid called leucovorin that you typically take once a week. Talk to your doctor about what's right for you.

Prompt: Help from folic acid?

CTA: Ease fatigue and headaches.

Conditions: Rheumatoid arthritis

Symptoms: loss of appetite, fatigue, feeling sick, symptoms worse in A.M., weakness, fever, lumps under skin, reduced joint movement, stiffness, stiffness after rest, anxiety, depression, deformed joint, stiff joint, swollen joint, warm joint, joint pain, muscle pain, pain, lower back pain, upper back pain, symmetrical pain, numbness, tingling, aching, burning, finger pain, elbow pain, knee pain, spinal pain, wrist pain, hand pain

Triggers: drug side effect, medication change

Treatments:auranofin (Ridaura), azathioprine (Azasan, Imuran), chlorambucil (Leukeran), cyclophosphamide, cyclosporine (GengrafNeoral), hydroxychloroquine (Plaquenil), leflunomide (Arava), methotrexate (Rheumatrex), minocycline (Minocin), mycophenolate mofetil (CellCept), myochrysine, sulfasalazine (Azulfidine)

Categories: meds

Treat Nausea

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Do methotrexate pills upset your stomach? It's a common side effect. Symptoms may be worst the first day or so after your weekly dose.

Ask your doctor which treatments can help. Taking a folic acid supplement if you routinely take methotrexate may ease nausea. Another option is to see if you can take methotrexate by injection instead. When injected, the drug no longer goes through your stomach. Some people find that helps with nausea.

Prompt: Upset stomach?

CTA: Ask for relief.

Conditions: Rheumatoid arthritis

Symptoms: nausea, vomiting, diarrhea, loss of appetite, fatigue, feeling sick, symptoms worse in A.M., weakness, fever, lumps under skin, reduced joint movement, stiffness, stiffness after rest, anxiety, depression, deformed joint, stiff joint, swollen joint, warm joint, joint pain, muscle pain, pain, lower back pain, upper back pain, symmetrical pain, numbness, tingling, aching, burning, finger pain, elbow pain, knee pain, spinal pain, wrist pain, hand pain

Trigger: drug side effect

Treatments:auranofin (Ridaura), azathioprine (Azasan, Imuran), chlorambucil (Leukeran), cyclophosphamide, cyclosporine (GengrafNeoral), hydroxychloroquine (Plaquenil), leflunomide (Arava), methotrexate (Rheumatrex), minocycline (Minocin), mycophenolate mofetil (CellCept), myochrysine, sulfasalazine (Azulfidine)

Categories: meds

Plaquenil and Eyes

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Anyone taking Plaquenil should see an eye doctor on a regular basis for an eye checkup. Although it's rare, Plaquenil can sometimes cause degeneration of the retina, which could lead to vision loss. A regular eye exam -- even if you don't wear glasses -- can help catch any potential problems early and avoid serious consequences. Ask your eye doctor how often you need an exam. It's usually annually, but frequency varies based on your risk factors.

Prompt: Plaquenil and eye health.

CTA: Get your eyes tested.

Conditions: Rheumatoid arthritis

Symptoms: vision changes, blind spots, blurred vision

Triggers: drug side effect, medication change

Treatments:auranofin (Ridaura), azathioprine (Azasan, Imuran), chlorambucil (Leukeran), cyclophosphamide, cyclosporine (GengrafNeoral), hydroxychloroquine (Plaquenil), leflunomide (Arava), methotrexate (Rheumatrex), minocycline (Minocin), mycophenolate mofetil (CellCept), myochrysine, sulfasalazine (Azulfidine)

Categories: meds

DMARDs and Pregnancy

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Some DMARDs can cause serious birth defects. Anyone using these drugs needs to use birth control to prevent an unexpected pregnancy.

If you're thinking about getting pregnant, talk to your doctor before you start trying. You may need to stop taking some meds for several months before trying to conceive. Your doctor may switch you to other meds to help control your RA symptoms.

Prompt: Planning a family?

CTA: Ask about RA meds first.

Conditions: Rheumatoid arthritis

Symptoms: loss of appetite, fatigue, feeling sick, symptoms worse in A.M., weakness, fever, lumps under skin, reduced joint movement, stiffness, stiffness after rest, anxiety, depression, deformed joint, stiff joint, swollen joint, warm joint, joint pain, muscle pain, pain, lower back pain, upper back pain, symmetrical pain, numbness, tingling, aching, burning, finger pain, elbow pain, knee pain, spinal pain, wrist pain, hand pain

Treatments:auranofin (Ridaura), azathioprine (Azasan, Imuran), chlorambucil (Leukeran), cyclophosphamide, cyclosporine (GengrafNeoral), hydroxychloroquine (Plaquenil), leflunomide (Arava), methotrexate (Rheumatrex), minocycline (Minocin), mycophenolate mofetil (CellCept), myochrysine, sulfasalazine (Azulfidine)

Categories: meds

DMARDS and Vaccines

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Before starting DMARD therapy, it’s important to make sure you are up to date on all routine vaccines such as the flu shot or pneumonia. You should also get the Shingrix vaccine for shingles, even if it has not yet been indicated. The older shingles vaccine contains live virus and should not be taken by someone with RA, DMARDs can lower your immunity so you should not get vaccinated while taking them. Make sure to speak to your doctor before taking any vaccine.

Prompt: DMARDS and Vaccinations

CTA: Protect your health with vaccines

Conditions: Rheumatoid arthritis

Symptoms: loss of appetite, fatigue, feeling sick, symptoms worse in A.M., weakness, fever, lumps under skin, reduced joint movement, stiffness, stiffness after rest, anxiety, depression, deformed joint, stiff joint, swollen joint, warm joint, joint pain, muscle pain, pain, lower back pain, upper back pain, symmetrical pain, numbness, tingling, aching, burning, finger pain, elbow pain, knee pain, spinal pain, wrist pain, hand pain

Treatments:auranofin (Ridaura), azathioprine (Azasan, Imuran), chlorambucil (Leukeran), cyclophosphamide, cyclosporine (GengrafNeoral), hydroxychloroquine (Plaquenil), leflunomide (Arava), methotrexate (Rheumatrex), minocycline (Minocin), mycophenolate mofetil (CellCept), myochrysine, sulfasalazine (Azulfidine)

Categories: meds

DMARDs and Illness

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DMARDs increase the risk of infection. Call your doctor if you notice any of these signs of infection:

* Fever

* Chills

* Sore throat

* Cough

If you do have an infection, you may need to get treated right away. Your doctor may also recommend that you stop taking the DMARD until you're better. However, never stop taking your DMARD -- or other prescribed medication -- without your doctor's approval. It could affect your RA and other health issues.

Prompt: DMARDs and infection.

CTA: When to call your doctor.

Conditions: Rheumatoid arthritis

Symptoms: fever, flu-like symptoms, cough, night sweats, stuffy nose, trouble breathing, loss of appetite, fatigue, feeling sick, symptoms worse in A.M., weakness, fever, lumps under skin, reduced joint movement, stiffness, stiffness after rest, anxiety, depression, deformed joint, stiff joint, swollen joint, warm joint, joint pain, muscle pain, pain, lower back pain, upper back pain, symmetrical pain, numbness, tingling, aching, burning, finger pain, elbow pain, knee pain, spinal pain, wrist pain, hand pain

Treatments: aauranofin (Ridaura), azathioprine (Azasan, Imuran), chlorambucil (Leukeran), cyclophosphamide, cyclosporine (GengrafNeoral), hydroxychloroquine (Plaquenil), leflunomide (Arava), methotrexate (Rheumatrex), minocycline (Minocin), mycophenolate mofetil (CellCept), myochrysine, sulfasalazine (Azulfidine)

Categories: meds

DMARD and Checkups

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Make sure you go to checkups so your doctor can keep tabs on your overall health. How often you need one depends on which DMARDs you take. Every 4 to 12 weeks, for instance, most people taking methotrexate need blood tests, tests to check kidney and liver functions, and blood counts.

Also keep doing the things you need to stay safe:

* Keep up with vaccinations

* Be sure to follow your doctor's advice about alcohol. Drinking more than recommended could be dangerous and lead to liver damage.

Prompt: Don't get too comfy.

CTA: Keep up with check-ups.

Conditions: Rheumatoid arthritis

Symptoms: loss of appetite, fatigue, feeling sick, symptoms worse in A.M., weakness, fever, lumps under skin, reduced joint movement, stiffness, stiffness after rest, anxiety, depression, deformed joint, stiff joint, swollen joint, warm joint, joint pain, muscle pain, pain, lower back pain, upper back pain, symmetrical pain, numbness, tingling, aching, burning, finger pain, elbow pain, knee pain, spinal pain, wrist pain, hand pain

Treatments:auranofin (Ridaura), azathioprine (Azasan, Imuran), chlorambucil (Leukeran), cyclophosphamide, cyclosporine (GengrafNeoral), hydroxychloroquine (Plaquenil), leflunomide (Arava), methotrexate (Rheumatrex), minocycline (Minocin), mycophenolate mofetil (CellCept), myochrysine, sulfasalazine (Azulfidine)

Categories: meds

Changes in Symptoms

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Sometimes a DMARD that has been reducing your symptoms starts to be less effective. If your symptoms are getting worse, call your doctor.

The good news is that you still have many med options. Your doctor may adjust your dosage or add a different medication. It may take some time, but you and your doctor will find another approach that helps.

Prompt: Symptoms getting worse?

CTA: Evaluate DMARDs.

Conditions: Rheumatoid arthritis

Symptoms: loss of appetite, fatigue, feeling sick, symptoms worse in A.M., weakness, fever, lumps under skin, reduced joint movement, stiffness, stiffness after rest, anxiety, depression, deformed joint, stiff joint, swollen joint, warm joint, joint pain, muscle pain, pain, lower back pain, upper back pain, symmetrical pain, numbness, tingling, aching, burning, finger pain, elbow pain, knee pain, spinal pain, wrist pain, hand pain

Treatments:auranofin (Ridaura), azathioprine (Azasan, Imuran), chlorambucil (Leukeran), cyclophosphamide, cyclosporine (GengrafNeoral), hydroxychloroquine (Plaquenil), leflunomide (Arava), methotrexate (Rheumatrex), minocycline (Minocin), mycophenolate mofetil (CellCept), myochrysine, sulfasalazine (Azulfidine)

Categories: meds

Show Sources

SOURCES:

Johns Hopkins Arthritis Center: "Rheumatoid Arthritis Treatment."

Johns Hopkins Arthritis Center: "Methotrexate and Nausea."

Johns Hopkins Arthritis Center: "Effects and Use of Methotrexate."

Johns Hopkins Arthritis Center: "Side Effects of Plaquenil."

Johns Hopkins Arthritis Center: "Pregnancy and Methotrexate."

Johns Hopkins Arthritis Center: "Enbrel plus Methotrexate: Family Planning."

Johns Hopkins Arthritis Center: "When Will I Get Some Relief from My Rheumatoid Arthritis?"

Arthritis Foundation: "Drug Guide: DMARDs."

Saag K. Arthritis & Rheumatism, 2008

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