DMARDiks

DMARDiks are medications used to treat autoimmune and inflammatory diseases by altering the underlying disease process rather than merely alleviating symptoms. They aim to slow or halt tissue and joint damage and to improve long-term outcomes in conditions such as rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, juvenile idiopathic arthritis, and some inflammatory bowel diseases.

DMARDiks are grouped into conventional synthetic DMARDs (csDMARDs), biologic DMARDs (bDMARDs), and targeted synthetic DMARDs (tsDMARDs). Conventional agents include methotrexate, leflunomide, sulfasalazine, and hydroxychloroquine. They may take several weeks to months to show benefit and are often used in combination with other therapies.

Biologic DMARDs are large molecules, typically monoclonal antibodies or receptor fusion proteins, that target specific components of the immune system. Common targets include TNF inhibitors such as etanercept, infliximab, and adalimumab, as well as agents aimed at IL-6, CD20, CTLA-4, or IL-1 pathways. Biologics are usually administered by injection or infusion and carry infection risks, including tuberculosis reactivation and hepatitis B, among others.

Targeted synthetic DMARDs are small oral molecules that inhibit intracellular signaling pathways, notably Janus kinase (JAK) inhibitors such as tofacitinib, baricitinib, and upadacitinib. They offer another option for patients who may not respond to biologics and require regular monitoring for cytopenias, liver function, lipid levels, and other safety considerations.

Therapy choice is tailored to disease type, activity, comorbidity, and patient preferences, with ongoing monitoring and vaccination considerations as part of standard care.