Medications categorized as disease-modifying antirheumatic drugs (DMARDs) are prescribed for treating rheumatoid arthritis (RA) and other autoimmune/inflammatory conditions, including ankylosing spondylitis, psoriatic arthritis, and lupus.

DMARDs are often referred to as immunosuppressants or immunomodulators because they appear to decrease inflammation by modifying the way your immune system works. This action helps slow down disease progression and alleviate symptoms.

The earliest DMARDs have been around for decades, so healthcare providers have a wealth of data to guide their treatment decisions. The medical community considers DMARDs to be highly effective long-term treatments. Most DMARDs take about three to six months to work, so you may not notice the benefits until you have been taking them for months.

DMARDs currently used for RA and similar conditions include:

If a DMARD isn't having sufficient effects, you may be prescribed two or more to take together. DMARDs are often prescribed with drugs from other classes as well.

While DMARDs do carry some risk of serious side effects, laboratory monitoring can help identify problems early.

This overview touches on some key information about each of these drugs. Speak to your healthcare provider about all possible side effects. Be detailed when sharing your medical and treatment history, including what medications you are currently taking, medications you're recently taken and side effects, your medical conditions, symptoms, and any drug allergies you have.

Arava was first approved by the U.S. Food and Drug Administration (FDA) in 1998. It comes in tablet form and is taken orally.

Arava is only approved for treating active RA in adults. It's sometimes used off-label for managing psoriatic arthritis and psoriasis.

Usually called by its generic name, sulfasalazine is a combination of salicylate and an antibiotic. This oral medication has been around since the 1940s and is available in tablet form.

Sulfasalazine is approved to treat mild-to-moderate ulcerative colitis (UC), as a first-line or combination treatment, and to prolong the period of remission between UC attacks. It can be used for adults and for children age 6 and over.

It's sometimes used to treat RA but has become less popular over time due to the risk of side effects and the availability of other treatment options. This medication is also rarely used for the treatment of psoriatic arthritis, Crohn's disease, IBD-associated arthritis, and juvenile idiopathic arthritis (JIA).

CellCept, an oral medication, has been on the market since 1995. It's an especially potent immunosuppressant.

This medication is FDA-approved to prevent organ rejection in kidney, heart, and liver transplants in adults, and kidney transplants in children. For its approved purposes, it's expected to be used alongside other immunosuppressants.

CellCept is sometimes used off-label for the treatment of RA, or for treatment of lupus with kidney disease, and vasculitis, as well as interstitial lung disease associated with autoimmune disorders, including RA and Sjogren's syndrome

Penicillamine is a distant relative of penicillin that became available in the 1970s. It's associated with a high incidence of severe side effects, including some that can be fatal. You'll need close monitoring by your healthcare provider if you take this drug.

This drug is FDA approved for treating:

This DMARD is not commonly used and it isn't a first-line treatment due to its risk of severe side effects. In fact, if you've been on 1,000 milligrams (mg) or more of penicillamine per day for a few months without improvement, your healthcare provider will likely recommend discontinuing it.

Imuran has been on the U.S. market since 1968. It is available in tablet form.

This drug is FDA approved for treating active RA and to prevent rejection in kidney transplants. It's sometimes used off-label to treat other autoimmune conditions, including dermatomyositis, systemic lupus erythematous (SLE), inflammatory bowel disease, and vasculitis.

Cyclosporine, under several brand names, has been on the market since 1983. Neoral and Gengraf are often used for the treatment of RA and other autoimmune conditions.

Another brand, Sandimmune, has a different level of bioavailability and therefore cannot be used interchangeably with Neoral and Gengraf.

Neoral/Gengraf is available in soft gel capsule and liquid forms.

Cyclosporine was originally approved to combat post-transplant organ rejection. Later, the form of the drug in Neoral and Gengraf gained approval for treating:

Cyclosporine is used off-label for treating conjunctivitis, Langerhans cells histiocytosis, autoimmune hepatitis, Duchenne muscular dystrophy, ulcerative colitis, and other diseases.

Plaquenil has been available since 1955 and was originally used to treat malaria. For a short time in 2020, the FDA gave it an emergency use authorization to treat COVID-19, but that authorization was revoked after a large clinical trial found it wasn't beneficial.

This drug is available in tablet form.

Plaquenil is approved for treating:

It's used off-label for treating pediatric forms of lupus, lupus nephritis, Sjögren's syndrome, other autoimmune diseases, and rash caused by sun sensitivity (polymorphous light eruption).

Known best by its generic name, methotrexate was FDA approved in 1953. This drug is the first-line therapy for moderate-severe RA. It's also widely used for treating psoriasis and cancer. A new injectable version, called RediTrex, gained approval in late 2019.

Serious warnings that come with the drug.

Methotrexate is available in tablets and an injectable liquid form.

Methotrexate is approved to treat:

RediTrex is not approved to treat cancer, but its indications are the same for RA, pJIA, and psoriasis.

Three newer types of DMARDs are now on the market. These may be tried after you've tried an older DMARD or used as combination therapy with an older DMARD without adequate improvement.

Biologics are drugs derived from living cells. They often work by blocking certain enzymes. For example, some biologics are TNFα inhibitors because they block the action of immune-system cells called tumor necrosis factor-alpha, which are associated with RA and other autoimmune disorders.

Common biologics:

Biosimilars are based on existing biologics. The FDA considers them to have no significant differences from their original reference drugs, but they can be less expensive. You can recognize them by the four-letter suffix after their generic name.

Common biosimilars include:

These drugs inhibit the activity of Janus kinase enzymes, which are involved in inflammation and autoimmunity.

Common JAK inhibitors are: