Systemic Antirheumatic Drugs (DMARD)
The choice of disease-modifying antirheumatic drug (DMARD) therapy is based on disease severity, comorbidities, and fertility plans.
Hydroxychloroquine or sulfasalazine monotherapy is best used for mild rheumatoid arthritis (RA).
Methotrexate (MTX) is the most effective anchor drug for all combination therapies.
Combination DMARD therapy is more effective than monotherapy in severe RA.
Patients need to be screened for G6PD deficiency
To be designated a DMARD, a drug must change the course of the disease for at least 1 year as evidenced by one of the following: sustained improvement in physical function, decreased inflammatory synovitis, slowing or prevention of structural joint damage
Most nonbiologic DMARDs take several months (3 to 6) to achieve a significant response. It is important to educate patients about this time frame of response so they are not discouraged when results are not seen immediately.
Methotrexat als "anchor drug" (German)