DMARDt

DMARDt is a term encountered in some medical texts and discussions as an informal label for disease-modifying antirheumatic therapies that emphasize targeted mechanisms. It is not part of a universally adopted nomenclature and is not consistently used in guidelines. The term may appear in reviews, conference materials, or regional practice documents where authors differentiate targeted approaches from traditional concepts of DMARD therapy.

In practice, DMARDt broadly encompasses conventional DMARDs, biologic DMARDs, and targeted synthetic DMARDs. Conventional DMARDs include methotrexate, sulfasalazine, leflunomide, and hydroxychloroquine. Biologic DMARDs comprise agents that inhibit specific cytokines or cell interactions, such as TNF inhibitors or IL-6 inhibitors, as well as therapies like abatacept or rituximab. Targeted synthetic DMARDs are small-molecule inhibitors that interfere with intracellular signaling pathways, such as JAK inhibitors.

Mechanism and goals: DMARDt aim to reduce inflammation, slow structural damage, and improve function by modifying the underlying immune processes rather than merely alleviating symptoms. Onset of benefit is gradual, and treatment often involves combination strategies and dose adjustments. Monitoring includes regular clinical assessment and laboratory tests (blood counts, liver and kidney function), with attention to infection risk and other adverse effects. Vaccination status should be up to date before initiating therapy when possible.

Indications and considerations: DMARDt are used in autoimmune inflammatory diseases such as rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, and certain juvenile arthropathies. Selection depends on disease activity, comorbidity, prior response, and safety profiles. Common practice often uses methotrexate as a backbone, with escalation to biologic or targeted agents as needed, while ongoing research explores new targets and improved safety.