Question: How do the older DMARDs differ from the newer DMARDs and is either group of drugs better for the treatment of rheumatoid arthritis?
Answer: There are older drugs, older DMARDs for use for rheumatoid arthritis, and there are newer ones. And each of these drugs have their strengths and weaknesses.
The older drugs are typically given by the oral route and can take a long time to work. Some of the medicines in this class are methotrexate, sulfasalazine, hydroxychloroquine -- and these are very very helpful for patients with rheumatoid arthritis.
However, many patients with rheumatoid arthritis do not have an adequate response to these medications so some of the newer medications can be used. These are medicines that are sometimes called biologic DMARDs and they target very unique mechanisms of inflammation in rheumatoid arthritis. They're usually given by injection and have a faster onset of action than the traditional oral DMARDs.
In truth, the best treatments for rheumatoid arthritis usually combine one of the older therapies with one of the newer therapies in combination. Patients on combination therapy tend to have less swelling, less stiffness, and less pain, and frequently note decrease progression of the disease.