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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Disease-modifying antirheumatic drugs (DMARDs): This group of drugs includes a wide variety of agents that work in many different ways. What they all have in common is that they interfere in the immune processes that promote inflammation in rheumatoid arthritis. DMARDs can actually stop or slow the progression of rheumatoid arthritis. They can also suppress the ability of the immune system to fight infections. Anyone taking one of these drugs must be very vigilant to watch for early signs of infection, such as fever, cough, or sore throat. Early treatment of infections can prevent more serious problems.

• Methotrexate (Rheumatrex, Folex PFS): We do not know exactly how this drug works in the treatment of inflammatory reactions. It relieves symptoms of inflammation such as pain, swelling, and stiffness. People taking methotrexate have to have regular blood tests to measure whether the drug is having any adverse effects on the liver, kidneys, or blood cells. This drug is not suitable for some people with liver problems or women who are or may become pregnant.
• Sulfasalazine (Azulfidine): This drug decreases inflammatory responses by an effect similar to that of aspirin or NSAIDs. People taking sulfasalazine must have regular blood tests to measure whether the drug is having any adverse effects on blood cells.
• Leflunomide (Arava): This drug interferes with cells of the immune system and reduces inflammation. It reduces symptoms and may even slow the progression of rheumatoid arthritis. People taking leflunomide must have regular blood tests to measure whether the drug is having any adverse effects on the liver or blood cells. This agent is not suitable for some people with liver or kidney problems or women who are or may become pregnant.
• Gold salts (aurothiomalate, auranofin [Ridaura]): These compounds contain very tiny amounts of the metal gold. We do not know why they stop inflammation. Apparently, the gold infiltrates into immune cells and interferes with their activities. People taking gold must have regular blood and urine tests to measure whether the drug is having any adverse effects on blood cells and the kidney.
• D-penicillamine: This agent combines with metals in the bloodstream and cells and removes them from the body. This suppresses certain actions of the immune system that promote rheumatoid arthritis. People taking D-penicillamine must have regular blood and urine tests to measure whether the drug is having any adverse effects on blood cells and the kidney.
• Hydroxychloroquine (Plaquenil): This drug was first used against the tropical parasite malaria. It inhibits certain cells that are necessary for the immune response that causes rheumatoid arthritis. People taking hydroxychloroquine must have eye examinations at least yearly to determine whether the drug is having any adverse effects on the retina.
• Azathioprine (Imuran): This drug stops the production of cells that are part of the immune response associated with rheumatoid arthritis. Unfortunately, it also stops production of some other types of cells and thus can have serious side effects. It strongly suppresses the entire immune system and thus leaves the person vulnerable to infections and other problems. It is used only in severe cases of rheumatoid arthritis that have not gotten better with other DMARDs. People taking azathioprine must have regular blood tests to measure whether or not the drug is having any adverse effects on blood cells. It is not used for women who are or may become pregnant.
• Cyclosporine (Neoral): This drug was developed for use in people undergoing organ transplantation or bone marrow transplantation. These people must have their immune system suppressed to prevent rejection of the transplant. Cyclosporine blocks an important immune cell and interferes with the immune response in several other ways. People taking cyclosporine must have regular blood tests and blood pressure checks to measure whether the drug is having any adverse effects on blood cells and blood pressure. It is not used for women who are or may become pregnant.

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