Antirheumatics: Uses, most common brand names, and safety information

Medically reviewed by  Jamie Winn, PharmD

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During the early 1900s, the treatment of rheumatoid arthritis was limited to medications that could only provide symptomatic relief such as salicylates, which were an early form of nonsteroidal anti-inflammatory drugs (NSAIDs).

Antirheumatics, or what we now call disease-modifying antirheumatic drugs (DMARDs) were established as treatments for rheumatic diseases starting with injectable gold in the 1930s. Today there are several DMARD treatment options that treat many diseases other than rheumatoid arthritis. They are used for other connective tissue diseases (lupus), autoimmune disorders, and some cancers. DMARDs are often prescribed with other medications such as corticosteroids or NSAIDs to help quickly relieve inflammation and pain.

The list below includes the most common DMARDs, combination products containing DMARDs, and their pricing:

List of Antirheumatics

What are Antirheumatics?

Disease-modifying antirheumatic drugs (DMARDs) are a group of medications that are used to reduce inflammation. DMARDs are also called immunosuppressants or immunomodulators because they change how your immune system functions. They are typically classified as:

• Conventional DMARDs. Sometimes called conventional synthetic, non-biologic, or traditional DMARDs, they are used to treat inflammatory conditions such as rheumatoid arthritis, psoriasis, and certain types of cancer. They are not indicated to treat osteoarthritis (OA). Conventional DMARDs work slowly and can take up to 12 weeks to see any improvements. Some commonly used examples include Trexall (methotrexate), Arava (leflunomide), and Plaquenil (hydroxychloroquine). These medications may be prescribed by themselves or as a combination therapy with other conventional or biologic DMARDs.
• Biologic DMARDs. Biologic DMARDs were first approved for use in the early 1990s for patients who had failed conventional DMARDs. They target specific receptors or cells in the immune system to reduce inflammation and prevent joint destruction. Biologic DMARDs tend to work faster than conventional DMARDs. Types of biologic DMARDs include monoclonal antibodies, tumor necrosis factor (TNF) inhibitors, interleukin-1 receptor antagonists, and targeted synthetic DMARDs, such as the Janus kinase inhibitors (JAK). Biological DMARDs are often given in combination with a conventional DMARD such as Trexall (methotrexate).

How do Antirheumatics work?

Conventional DMARDs suppress your body’s immune and inflammatory responses by inhibiting B cells and T cells in the immune system.

Biologic DMARDs work by blocking or modifying your immune system’s inflammatory response. They target specific cells or cytokines (proteins) to reduce pain, inflammation, and cartilage or joint damage.

What conditions are Antirheumatics used to treat?

DMARDs are prescribed to treat many conditions, including:

• Rheumatoid arthritis (RA)
• Psoriatic arthritis (PsA)
• Ankylosing spondylitis (AS)
• Systemic lupus erythematosus (SLE)
• Crohn’s disease
• Systemic sclerosis
• Multiple sclerosis
• Sjögren’s syndrome
• Inflammatory myositis
• Vasculitis
• Inflammatory bowel disease
• Uveitis
• Certain types of cancer

Are Antirheumatics safe?

When taken as prescribed, DMARDs can be safe and effective. Before starting a DMARD, your doctor may take a baseline x-ray and blood tests. Your disease progression and potential side effects will also be monitored during treatment.

Your healthcare provider should also be aware of your current health conditions, including:

• Any active infections
• Leukopenia (low white blood cell count)
• Liver disease (methotrexate and leflunomide should be avoided)
• Cardiovascular disease
• Immunodeficiency disorders
• Are pregnant or plan on becoming pregnant
• Are breastfeeding or plan on breastfeeding

Can you take Antirheumatics while you are pregnant or breastfeeding?

Some of the most common DMARD therapies such as Trexall (methotrexate) and Arava (leflunomide) are contraindicated in pregnancy and lactation. Azulfidine (sulfasalazine) and Plaquenil (hydroxychloroquine) are generally considered safe to be used during pregnancy.

Among the biologic DMARDs, anti-TNF drugs such as Cimzia (certolizumab) are considered safe to use during pregnancy. There isn’t enough evidence to support the use of other biologic DMARDs during pregnancy or lactation. You should discuss the risks with your healthcare provider to determine if these medications should be included in your treatment plan.

What are the common side effects of Antirheumatics?

Some common side effects of DMARDs include:

• Decreased appetite
• Nausea
• Rash
• Diarrhea
• Stomach pain
• Mouth sores
• Hair loss (alopecia)
• Weight loss

DMARDs can sometimes cause severe adverse effects, including:

• Increased risk of serious infections
• Increased risk of blood clots
• Liver impairment, increased liver enzymes, and cirrhosis
• Low blood counts from bone marrow suppression
• Worsening congestive heart failure
• Tuberculosis
• Herpes zoster
• Hepatitis B and C

This is not a complete list of side effects and we encourage you to consult with your healthcare professional for medical advice about any possible side effects.

How much do Antirheumatics cost?

DMARDs are very expensive with an average cost of around $10,000 per year.

You can purchase antirheumatics for $49 per month from NiceRx if eligible for assistance. Prices at the pharmacy vary by location, strength, and quantity, as well as your insurance status.

Related resources for Antirheumatics

• Disease-Modifying Antirheumatic Drugs (DMARDS). Cleveland Clinic
• Disease-modifying antirheumatic drugs stop or slow the disease process in inflammatory forms of arthritis. Arthritis.org
• Disease Modifying Anti-Rheumatic Drugs (DMARD). National Library of Medicine
• Treating Rheumatoid Arthritis With Disease-Modifying Drugs (DMARDs). WebMD
• Rheumatoid Arthritis Medication List. Healthline
• Pregnancy in Rheumatic Disease: Managing Potentially Teratogenic Medications. Rheumatology Advisor