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Disease Modifying Anti Rheumatic Drugs (DMARD)
An Era of New Therapy using Biologic DMARD and Synthetic Target in Treating Rheumatic Diseases:
SUMMARY POINTS/ FACT SHEET

by DR ARVIND CHOPRA

Disclaimer: These are clinical practice guidelines and general information for patients. It is mandatory to consult rheumatologist prior to therapeutic use. Do not self-treat in any case.
Introduction: In this article, some basic descriptions are provided to understand the disease modifying anti rheumatic drugs (DMARD) which are pivotal in the management of several autoimmune immune inflammatory rheumatic disorders. Rheumatoid arthritis (RA) is a typical example and the focus in this fact sheet. Conventional DMARDs include Hydroxychloroquine, Sulfasalazine, Methotrexate, Leflunomide and are often used when patients are first diagnosed with RA. Methotrexate is the most popular and pivotal DMARD in RA. Conventional DMARD have been used to treat several rheumatological disorders for over 40 years and can be used for prolonged periods lasting several years. Biologic drugs are advanced DMARD in the form of injections and used when disease is aggressive and not well controlled with conventional DMARD. In RA, methotrexate is usually continued along with a Biological DMARD for better long-term response... There is a wide variety of Biologic DMARD agents belonging to different classes (such as anti-tumour necrosis agents, B-cell inhibitors, Interleukin 6 inhibitors) with almost equal efficacy and safety and the choice is often based on preference by the patient, experience of the specialist, price of the drug and ease of administration and monitoring. In the last decade a new class of very effective DMARD drugs called JAK inhibitors has been approved to treat RA and other disorders. JAK inhibitors are oral drugs with very specific action on a particular inflammatory process in RA and other disorders and are now being considered at par with Biological DMARD agents. It should be noted that no DMARD will work in every patient. This is also true of Biologic agents and JAK inhibitors. But based on the clinical profile of RA and presence of complications and other coexisting diseases, a rheumatologist can make a good decision on the choice of DMARD. Sometimes, these drugs need to be changed when the disease control is inadequate or in case of drug side effects or some complication
All types of DMARDs require selection and monitoring by rheumatologist.


CONVENTIONAL DMARDS:

 

BIOLOGIC DMARD

 

SYNTHETIC TARGET DMARD (JAK Inhibitors):

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