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    3. Rheumatology
    4. DMARD Therapy

    DMARD Therapy

    At Mayo Clinic Healthcare in central London, our rheumatology specialists provide expert assessment and DMARD treatment for inflammatory arthritis and certain autoimmune rheumatic diseases.

    If you have rheumatoid arthritis or another inflammatory condition, our team will work with you to develop a personalised treatment plan. The aim is to control disease activity, ease symptoms, and protect your joints and other tissues from long-term damage.

    Disease-modifying antirheumatic drugs, commonly called DMARDs, are a main part of treatment for many inflammatory rheumatic conditions. For rheumatoid arthritis, starting treatment soon after diagnosis can help control the condition and reduce the risk of permanent joint damage.

    • DMARD stands for disease-modifying antirheumatic drug.

      Pain-relieving medicines may ease symptoms, but DMARDs can also change the course of an inflammatory condition. They reduce disease activity and help protect joints and other tissues from long-term damage.

      DMARDs are most commonly used to treat rheumatoid arthritis. They may also be prescribed for conditions such as psoriatic arthritis and certain connective tissue diseases.

      Many DMARDs affect immune-system activity. Depending on the medicine, it may take several weeks or months before you notice its full effect.

    • Your rheumatology specialist may recommend DMARD treatment after diagnosing an inflammatory arthritis or another autoimmune rheumatic condition.

      Conditions treated with DMARDs may include:

      The right medicine will depend on your diagnosis, disease activity, overall health, other medicines, and treatment goals.

      Your consultant will explain the expected benefits, possible side effects, and monitoring requirements before you begin treatment.

    • DMARDs are the main long-term medicines used to treat rheumatoid arthritis. They control the immune activity that causes inflammation and can reduce the risk of permanent damage.

      Treatment often starts soon after diagnosis. NICE recommends offering a conventional DMARD as soon as possible and ideally within three months of the start of persistent symptoms.

      Common conventional DMARDs used for rheumatoid arthritis include:

      • Methotrexate

      • Sulfasalazine

      • Hydroxychloroquine

      • Leflunomide

      Your consultant will recommend a medicine based on your condition, health, and preferences. More than one conventional DMARD may sometimes be used.

      If conventional DMARDs do not control the condition adequately, your consultant may discuss a biological DMARD or targeted synthetic DMARD. The treatment available to you will depend on your diagnosis, previous treatment, and relevant clinical guidance.

    • Before treatment begins, your consultant will assess whether a DMARD is appropriate and safe for you.

      Your assessment may include:

      • A discussion about your symptoms and medical history

      • A review of the medicines and supplements you take

      • An examination of your joints and general health

      • Blood tests to check your blood cell counts, liver and kidneys

      • A review of your vaccination history

      • Screening for infections, based on the medicine and your individual risk

      • A discussion about pregnancy, breastfeeding or fertility where relevant

      • Imaging, such as an X-ray or ultrasound, if needed to assess inflammation or joint damage

      Pretreatment checks vary between medicines. Your consultant will explain which assessments you need.

    • Some DMARDs can affect your blood cell counts, liver, or kidneys. Regular blood tests help your care team identify possible side effects and decide whether your treatment or dose needs to change.

      A DMARD blood test may include:

      • A full blood count to measure your red blood cells, white blood cells, and platelets

      • Liver function tests

      • Kidney function tests

      Your care team may also use inflammatory markers to assess your condition. These tests measure disease activity rather than medicine safety.

      The type and frequency of monitoring depend on:

      • The DMARD you take

      • How recently you started treatment

      • Changes to your dose

      • Your test results

      • Other health conditions

      • Your individual risk of side effects

      Monitoring is often more frequent during the first months of treatment. It may become less frequent once your dose and results are stable. Current BSR guidance recommends that monitoring be adjusted according to the medicine and the person’s risk of toxicity.

      Not every DMARD requires the same blood tests. For example, hydroxychloroquine generally requires regular eye assessments rather than the routine blood-test schedule used for medicines such as methotrexate.

      Your consultant will give you a personalised monitoring schedule.

    • DMARD treatment is tailored to your diagnosis, disease activity, previous treatment and overall health.

      Your care plan may include:

      Conventional synthetic DMARD

      These medicines reduce disease activity and help prevent long-term damage. They are often the first DMARDs prescribed for rheumatoid arthritis and some other inflammatory conditions.

      Biological DMARDs

      Biological DMARDs target specific parts of the immune system involved in inflammation. They may be considered when conventional treatment has not controlled the condition adequately.

      Targeted synthetic DMARDs

      These medicines act on specific immune pathways within cells. Like biological medicines, they may be considered for certain conditions when other treatments have not been sufficiently effective or suitable.

      Regular monitoring

      Appointments, examinations, and tests help your care team assess how well treatment is working and look for possible side effects.

      Coordinated care

      Your consultant may work with specialist nurses, physiotherapists, and other healthcare professionals to help you manage symptoms, maintain mobility, and support your overall health.

    • Patients choose Mayo Clinic Healthcare for access to experienced rheumatology specialists and coordinated care for inflammatory joint conditions.

      Our approach includes:

      • Consultant-led assessment and treatment planning

      • Personalised DMARD treatment based on your diagnosis and needs

      • Monitoring tailored to your medicine and health

      • Clear information about benefits, risks, and treatment options

      • Collaboration between rheumatology, diagnostic imaging, and physiotherapy specialists

      • Evidence-based care informed by globally recognised Mayo Clinic expertise

      We will help you understand your condition, consider your options and make informed decisions about your care.

    Private health insurance for rheumatology treatment

    Mayo Clinic Healthcare works with all major private health insurance providers, including AXA PPP, Aviva, BUPA, Health Partners Group, Vitality Health and WPA. Self-pay arrangements are also available.

    Request an Appointment

    If you have inflammatory arthritis or would like to discuss DMARD treatment, our rheumatology specialists can assess your condition and explain the treatment options that may be appropriate for you.

     

    Medically Reviewed by

    Dr Anna Nuttall, Consultant Rheumatologist

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