Non-biologic disease modifying anti-rheumatic drugs (DMARDs)

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Non-biologic disease modifying anti-rheumatic drugs (DMARDs)

Medicine and surgery

Allergy and immunology

Antihistamines for allergies


Cardiology, cardiac surgery and vascular surgery

Coronary artery disease: Clinical (To be retired)

Heart failure: Clinical (To be retired)

Syncope: Clinical (To be retired)

Hypertension: Clinical (To be retired)

Hypercholesterolemia: Clinical (To be retired)

Peripheral vascular disease: Clinical (To be retired)

Leg ulcers: Clinical (To be retired)

Adrenergic antagonists: Alpha blockers

Adrenergic antagonists: Beta blockers

ACE inhibitors, ARBs and direct renin inhibitors

Thiazide and thiazide-like diuretics

Calcium channel blockers

Lipid-lowering medications: Statins

Lipid-lowering medications: Fibrates

Miscellaneous lipid-lowering medications

Antiplatelet medications

Dermatology and plastic surgery

Hypersensitivity skin reactions: Clinical (To be retired)

Eczematous rashes: Clinical (To be retired)

Papulosquamous skin disorders: Clinical (To be retired)

Alopecia: Clinical (To be retired)

Hypopigmentation skin disorders: Clinical (To be retired)

Benign hyperpigmented skin lesions: Clinical (To be retired)

Skin cancer: Clinical (To be retired)

Endocrinology and ENT (Otolaryngology)

Diabetes mellitus: Clinical (To be retired)

Hyperthyroidism: Clinical (To be retired)

Hypothyroidism and thyroiditis: Clinical (To be retired)

Dizziness and vertigo: Clinical (To be retired)

Hyperthyroidism medications

Hypothyroidism medications


Hypoglycemics: Insulin secretagogues

Miscellaneous hypoglycemics

Gastroenterology and general surgery

Gastroesophageal reflux disease (GERD): Clinical (To be retired)

Peptic ulcers and stomach cancer: Clinical (To be retired)

Diarrhea: Clinical (To be retired)

Malabsorption: Clinical (To be retired)

Colorectal cancer: Clinical (To be retired)

Diverticular disease: Clinical (To be retired)

Anal conditions: Clinical (To be retired)

Cirrhosis: Clinical (To be retired)

Breast cancer: Clinical (To be retired)

Laxatives and cathartics


Acid reducing medications

Hematology and oncology

Anemia: Clinical (To be retired)

Anticoagulants: Warfarin

Anticoagulants: Direct factor inhibitors

Antiplatelet medications

Infectious diseases

Pneumonia: Clinical (To be retired)

Urinary tract infections: Clinical (To be retired)

Skin and soft tissue infections: Clinical (To be retired)

Protein synthesis inhibitors: Aminoglycosides

Antimetabolites: Sulfonamides and trimethoprim

Miscellaneous cell wall synthesis inhibitors

Protein synthesis inhibitors: Tetracyclines

Cell wall synthesis inhibitors: Penicillins

Miscellaneous protein synthesis inhibitors

Cell wall synthesis inhibitors: Cephalosporins

DNA synthesis inhibitors: Metronidazole

DNA synthesis inhibitors: Fluoroquinolones

Herpesvirus medications



Miscellaneous antifungal medications

Anti-mite and louse medications

Nephrology and urology

Chronic kidney disease: Clinical (To be retired)

Kidney stones: Clinical (To be retired)

Urinary incontinence: Pathology review

ACE inhibitors, ARBs and direct renin inhibitors

PDE5 inhibitors

Adrenergic antagonists: Alpha blockers

Neurology and neurosurgery

Stroke: Clinical (To be retired)

Lower back pain: Clinical (To be retired)

Headaches: Clinical (To be retired)

Migraine medications

Pulmonology and thoracic surgery

Asthma: Clinical (To be retired)

Chronic obstructive pulmonary disease (COPD): Clinical (To be retired)

Lung cancer: Clinical (To be retired)

Antihistamines for allergies

Bronchodilators: Beta 2-agonists and muscarinic antagonists

Bronchodilators: Leukotriene antagonists and methylxanthines

Pulmonary corticosteroids and mast cell inhibitors

Rheumatology and orthopedic surgery

Joint pain: Clinical (To be retired)

Rheumatoid arthritis: Clinical (To be retired)

Lower back pain: Clinical (To be retired)

Anatomy clinical correlates: Clavicle and shoulder

Anatomy clinical correlates: Arm, elbow and forearm

Anatomy clinical correlates: Wrist and hand

Anatomy clinical correlates: Median, ulnar and radial nerves

Anatomy clinical correlates: Bones, joints and muscles of the back

Anatomy clinical correlates: Hip, gluteal region and thigh

Anatomy clinical correlates: Knee

Anatomy clinical correlates: Leg and ankle

Anatomy clinical correlates: Foot

Acetaminophen (Paracetamol)

Non-steroidal anti-inflammatory drugs


Opioid agonists, mixed agonist-antagonists and partial agonists

Antigout medications

Non-biologic disease modifying anti-rheumatic drugs (DMARDs)

Osteoporosis medications

Memory Anchors and Partner Content


Content Reviewers

Antonia Syrnioti, MD


Anuj Paul

Jerry Ferro

Cassidy Dermott

Talia Ingram, MSMI, CMI

Disease-modifying anti-rheumatic drugs, or DMARDs for short, are a group of medications primarily used to modify or slow down the progression of rheumatoid arthritis. Now, there are two types of DMARDs, biologic DMARDs, which are developed from microorganisms, animals, or humans, and non-biologic DMARDs, which are chemically synthesized in the laboratory. In this video, we’ll particularly focus on the non-biologic DMARDs.

Alright, first let’s talk about physiology eal quick. During the S phase of the cell cycle, the cell performs DNA replication. DNA is composed of a sequence of deoxyribonucleotides and each deoxyribonucleotide is made out of a phosphate group, a five-carbon sugar like deoxyribose, and a nucleobase, which can be either a pyrimidine like cytosine, or thymidine, or a purine like adenine or guanine. Now, pyrimidine synthesis starts when folic acid, or vitamin B9, from our diet, is converted into dihydrofolate or DHF. DHF then gets converted by an enzyme called dihydrofolate reductase or DHFR into tetrahydrofolate, or THF.

THF acts as a mediator and accepts a methyl group from the amino acid serine, becoming 5,10-methyl-THF. This methyl group is then used by an enzyme called thymidylate synthetase, which transfers it to dUMP or deoxyuridine monophosphate, turning it to dTMP or deoxythymidine monophosphate. dTMP then through a series of reactions eventually turns into thymine. And at that point, we’re all set to make DNA.

At the same time, purine synthesis starts with the amino acids glutamine, aspartate, and glycine, together with bicarbonate and formate, which is the anion derived from formic acid. These undergo a ten-step pathway and the result is inosine monophosphate, or IMP, which is a precursor to adenine and guanine. And at that point, we’re all set to make DNA.

Okay, now, rheumatoid arthritis or RA for short is a chronic, progressive, inflammatory disorder that affects synovial joints and, sometimes, other parts of the body like the skin and the lungs. It is thought to be an autoimmune reaction, however, the exact cause is unknown. Generally speaking, it seems to be associated with environmental risk factors like infections and smoking, and with a genetic predisposition like having the alleles HLA-DR1 and HLA–DR4.

So basically, cells of the immune system, including T-cells, and macrophages, enter the joint space and start releasing inflammatory cytokines, like tumor necrosis factor, or TNF-α, interleukin- 1 or IL-1, and interleukin- 6, or IL-6. These cytokines stimulate synovial cells to proliferate and create a pannus, which is a thick, swollen synovial membrane with granulation or scar tissue, made up of fibroblasts, myofibroblasts, and inflammatory cells. Over time, the cytokines released in the pannus start to break down the articular cartilage, eventually leading to bone erosion.


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