DMARDs (Disease-Modifying Antirheumatic Drugs): Types, Side Effects, and How Long They Take to Work
Updated: 6 days ago
Written and medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026 · How we review
Quick Answer: What are DMARDs?
Disease-modifying antirheumatic drugs (DMARDs) are prescription medicines that calm an overactive immune system to reduce inflammation, ease pain, and slow joint and bone damage. They treat rheumatoid arthritis, lupus, psoriatic arthritis, and other immune-related conditions. Traditional DMARDs are usually pills, and biologics are infusions or injections. Both take weeks to work and need regular blood tests. [1]
What the research says
Starting early protects joints for years. In a meta-analysis of 12 studies in early rheumatoid arthritis, people who started DMARDs early had about 33% less long-term joint damage on X-rays than people who started later, with the benefit lasting up to 5 years. (Finckh et al., Arthritis & Rheumatism, 2006)
A biologic plus methotrexate works better than methotrexate alone. A review of 22 studies (9,934 adults with early rheumatoid arthritis) found the combination raised the chance of a 50% improvement in symptoms by 20% to 57%, depending on the biologic, with no significant rise in people stopping treatment because of side effects. (Donahue et al., Journal of General Internal Medicine, 2019)
TNF-inhibitor biologics raise tuberculosis risk, so screening matters. In 29 trials (11,879 patients), 0.57% of people on TNF inhibitors developed tuberculosis, compared with 3 of 3,967 people in control groups. That is close to twice the odds (odds ratio 1.94), although the evidence was rated low certainty. (Zhang et al., BMJ Open, 2017)
Key takeaways
DMARDs are immunosuppressants that slow the disease itself, not just the pain. [1]
There are two main groups: traditional DMARDs (usually pills) and biologics (infusions or injections). [1]
Traditional DMARDs are often tried first because they tend to cause fewer side effects. [1]
Relief is not immediate. Expect several weeks for biologics and a month or more for traditional DMARDs. [1]
You will need regular blood tests, infection screening and sometimes X-rays while you take them. [1]
What are DMARDs and how do they work?
DMARDs are prescription medicines that calm an overactive immune system. They belong to a larger group of drugs called immunosuppressants. [1]
In autoimmune and inflammatory diseases, the immune system attacks the body's own healthy tissue. DMARDs turn that attack down. [1]
Unlike simple painkillers, DMARDs change the course of the disease. They help to: [1]
Reduce inflammation
Relieve pain
Slow how fast the disease progresses
Limit damage to joints and bones
Preserve how well your joints work
What conditions do DMARDs treat?
DMARDs treat a range of autoimmune and inflammatory conditions, most often types of inflammatory arthritis. [1]
Area of the body | Conditions treated with DMARDs |
Joints and spine | |
Whole body (systemic) | Lupus, scleroderma, Sjögren's, myositis, rheumatoid vasculitis |
Gut | Inflammatory bowel disease, including Crohn's disease |
Nervous system | Multiple sclerosis |
Less common uses | Some cancers; non-infectious uveitis (eye inflammation) that has not responded to other treatment |
What are the types of DMARDs?
DMARDs come in two main types: traditional DMARDs and biologics. A third group, JAK inhibitors, works in a similar way to biologics. [1]
In medical terms, these groups are called conventional synthetic, biologic and targeted synthetic DMARDs. [2]
Traditional DMARDs
Traditional DMARDs act broadly on the whole immune system. They are usually taken as oral pills. [1]
Doctors often try them before biologics because they tend to cause fewer side effects. [1]
Common examples include: [1]
Methotrexate
Hydroxychloroquine
Sulfasalazine
Leflunomide
Azathioprine
Biologics
Biologics are protein-based medicines that target specific immune cells. They are often more effective, but they are stronger and carry a higher risk of side effects. [1]
You usually get them as an IV infusion or as an injection under the skin that you can give yourself. They are typically used when traditional DMARDs have not worked well enough. [1]
The main biologic groups are: [1]
TNF inhibitors
Interleukin inhibitors
T-cell inhibitors
B-cell inhibitors
JAK inhibitors
Janus kinase (JAK) inhibitors are not technically biologics, but they work in a similar way. They carry an FDA boxed warning for serious infections, blood clots, heart attack, stroke, certain cancers and death. [1]
Feature | Traditional DMARDs | Biologics |
How they act | Broadly, on the whole immune system | Target specific immune cells |
Usual form | Oral pills | IV infusion or self-injection under the skin |
When they are used | Often first | Usually after traditional DMARDs fall short |
Strength | Milder | Often more effective, but stronger |
Side-effect risk | Tends to be lower | Higher |
Time to start working | A month or more | Usually several weeks |
Source: [1]
Can DMARDs be combined with other medicines?
DMARDs can be used alone or combined with other medicines to get better control of the disease. [1]
Common combinations include: [1]
A DMARD plus corticosteroids or other medicines
Two or more traditional DMARDs together
A traditional DMARD plus a biologic
Your provider's goal is to find the mix that works best with the fewest side effects. [1]
What are the side effects of DMARDs?
DMARD side effects depend on the type, but both types raise the risk of infection. That risk is higher with biologics. [1]
Side effect | Traditional DMARDs | Biologics |
Higher risk of infections | ✔ | ✔ (higher) |
Low white blood cell, red blood cell or platelet counts | ✔ | ✔ |
Raised liver enzymes | ✔ | ✔ |
Loss of appetite, nausea, vomiting | ✔ | — |
Diarrhea or belly pain | ✔ | — |
Skin rash | ✔ | — |
Old infections becoming active again (tuberculosis, herpes, hepatitis) | — | ✔ |
Raised cholesterol | — | ✔ |
Higher risk of blood clots | — | ✔ |
Reactions where the injection or infusion was given | — | ✔ |
Source: [1]
Because infections such as tuberculosis can wake up again on biologics, your provider will screen you for them, especially if you have a chronic infection. Methotrexate and leflunomide can cause miscarriage and birth defects, so they must not be taken during pregnancy; talk to your provider before trying to conceive. [1]
How long do DMARDs take to work?
DMARDs take at least a few weeks to start working, so you will not feel relief right away. [1]
Biologics usually begin to work after several weeks. [1]
Traditional DMARDs can take a month or more. [1]
What monitoring do you need while taking DMARDs?
People taking DMARDs need regular check-ups to make sure the medicine is working and is not causing harm. [1]
Test or check | Why it is done |
Blood tests | To check how well the medicine works and to catch side effects such as low blood counts or raised liver enzymes |
Infection screening | To find infections that could become active, especially in people with chronic infections |
Imaging, such as X-rays | To track changes in your joints over time |
Follow-up visits | Your provider decides how often you need them |
Source: [1]
When should you contact your provider about DMARDs?
Contact your provider if you notice any of these while taking a DMARD: [1]
New side effects, or side effects that are getting worse
Symptoms that come back more often
The feeling that your medicine is not working as well as it did
Conclusion
DMARDs are the medicines that do more than ease symptoms. They calm an overactive immune system and slow the damage that autoimmune diseases cause to joints, bones and organs. [1]
Traditional DMARDs are usually the first step. Biologics and JAK inhibitors come in when stronger, more targeted control is needed. [1]
The trade-off is a higher risk of infection, a wait of several weeks before you feel better, and regular blood tests. Knowing this ahead of time makes it easier to stay on track and spot problems early. [1]
Your next step: Save or print this guide and bring it to your next appointment. Use the side-effect and monitoring tables to ask your provider which DMARD fits you, how long to wait before judging results, and how often you will need blood tests. To learn more about the condition behind your prescription, read our guides to rheumatoid arthritis, psoriatic arthritis and lupus.
FAQ
What does DMARD stand for?
DMARD stands for disease-modifying antirheumatic drug. These prescription medicines calm an overactive immune system to slow the disease itself, not only its symptoms. [1]
What are the most common DMARDs?
The most common traditional DMARDs are methotrexate, hydroxychloroquine, sulfasalazine, leflunomide and azathioprine. Biologic DMARDs include TNF inhibitors, interleukin inhibitors, T-cell inhibitors and B-cell inhibitors. [1]
Is a biologic the same as a DMARD?
A biologic is one type of DMARD. Biologics are protein-based and target specific immune cells, while traditional DMARDs act broadly on the immune system. [1]
How long does it take for DMARDs to work?
DMARDs take at least a few weeks to work. Biologics usually start working after several weeks, and traditional DMARDs can take a month or more. [1]
What are the main side effects of DMARDs?
The main side effects shared by all DMARDs are a higher risk of infection, low blood cell counts and raised liver enzymes. Traditional DMARDs can also cause nausea, diarrhea and rash, while biologics can reactivate old infections and raise cholesterol. [1]
Why do I need blood tests while taking a DMARD?
Blood tests show whether the DMARD is working and catch side effects such as low blood counts or raised liver enzymes early. Your provider decides how often you need them. [1]
Can DMARDs be taken together?
Yes, DMARDs can be combined. A provider may pair two traditional DMARDs, a traditional DMARD with a biologic, or a DMARD with corticosteroids to find the best result with the fewest side effects. [1]
When should I call my doctor while taking a DMARD?
Call your provider if side effects are new or getting worse, if symptoms come back more often, or if the medicine seems to work less well. [1]
Can I get vaccines while taking a DMARD?
Most inactivated vaccines, such as the flu shot, are recommended for people on DMARDs. Live vaccines may need to be avoided with some DMARDs, especially biologics, so ask your provider before any vaccine.
Can I take DMARDs during pregnancy?
Some DMARDs, including methotrexate and leflunomide, can cause miscarriage and birth defects and must not be taken during pregnancy. Others may be safer, so plan pregnancy with your provider.
Related Reading
Biosimilars: What They Are, Safety and How They Compare to Biologics explains biosimilar medicines.
Biologics: What They Are, Types, Uses and Side Effects explains biologic medicines and how they're used.
References
Cleveland Clinic. Disease-Modifying Antirheumatic Drugs (DMARDs). Cleveland Clinic. Last updated November 1, 2024. https://my.clevelandclinic.org/health/treatments/disease-modifying-antirheumatic-drugs-dmards
Nimmana BK, Patel P. Disease-Modifying Antirheumatic Drugs (DMARDs). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Updated December 13, 2025. https://www.ncbi.nlm.nih.gov/books/NBK507863/
Finckh A, Liang MH, van Herckenrode CM, et al. Long-term impact of early treatment on radiographic progression in rheumatoid arthritis: A meta-analysis. Arthritis & Rheumatism. 2006;55(6):864-872. PMID: 17139662. https://doi.org/10.1002/art.22353
Donahue KE, Schulman ER, Gartlehner G, et al. Comparative Effectiveness of Combining MTX with Biologic Drug Therapy Versus Either MTX or Biologics Alone for Early Rheumatoid Arthritis in Adults: a Systematic Review and Network Meta-analysis. Journal of General Internal Medicine. 2019;34(10):2232-2245. PMID: 31388915. https://doi.org/10.1007/s11606-019-05230-0
Zhang Z, Fan W, Yang G, et al. Risk of tuberculosis in patients treated with TNF-α antagonists: a systematic review and meta-analysis of randomised controlled trials. BMJ Open. 2017;7(3):e012567. PMID: 28336735. https://doi.org/10.1136/bmjopen-2016-012567
Medical disclaimer
This article is for general education only and does not replace advice from your doctor or pharmacist. Never start, stop or change a DMARD or any prescription medicine without talking to the provider who prescribed it.
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