Traditional DMARDS and Biologics mechanism of action

General
1

Can someone explain to me how traditional DMARDS actually modify the disease?

I have read about the mechanism involved in biologics and understand that these are designed to treat the source of the disease actually prevent the mechanism involved.

However the only information I have found in respect to traditional DMARDs is related to reducing inflammation.

For me that suggests treating the symptoms and not modifying the disease.

Is the name a misnomer?

I have also read that apparently there is no evidence to suggest that traditional DMARDs are effective in treating PsA , only RA.

2

Well ā€¦ it does look a lot like that, doesnā€™t it, ktel? As time goes on, the impression I get is very similar to yours.

My own experience with DMARDS (and I took all of them, in various combinations) was a total bust, unlike my experience with biologics.

But as for going so far as to call it a misnomer, Iā€™m not qualified to say. :blush:

3

Its a misnomer unless you realize the real misnomer is when we seperate Biologics from DMARDS. Biologics are also DMARDS. The correct Nomenclature is ā€œtraditional DMARDSā€ and ā€œbiologic DMARDSā€

Yes they effect ā€œinflammationā€ but unlike NSAIDS both effect the mechanism causing inflammation. Traditional DMARDS effect all cytokines, The Biologic DMARDS target specifically the interleukins. We started with TNF-A and other more recent versions have gone after IL-6 and even IL4. Now if these are the cause, we are in good shape but the immune system doesnā€™t discriminate as well as it should. There are over 30 of these buggers than rear their ugly heads so they still use the Traditional DMARDs. as well as NSAIDS for a more immediate response Some of us recieve pretty good results from the combo others not so muchā€¦

Clear as mud eh?

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4

Yes I was referring to traditional DMARDs v Biologic DMARDs.

Do you have a link to any information for the traditional DMARDs that explains how they effect the mechanism?

5

This and ther beyond the basics links ought to keep you busy for a while

Also:

http://www.arthritis.org/living-with-arthritis/treatments/medication/drug-types/disease-modifying-drugs/drug-guide-dmards.php

Dr. Liu has written a ton

https://scholar.google.com/citations?user=7QZDE3oAAAAJ&hl=en

FWIW Scholar.google.com is ALWAYS your best source:

6

Hi Ktel,

To be honest I had exactly the same questions. Thereā€™s lots of generic information about traditional DMARDs, but it seems to lack the mechanism of action type info you can find for the biologics.

I chatted to my Rheumy about this issue with methotrexate, one appointment where everything was going so well on Humira I didnā€™t have much else to say!

He essentially admitted they still donā€™t know how it works - there are theories related to both anti-inflammation and immune suppression, they seem more recently to be favouring an anti-inflammatory pathway - but at the end of the day, methotrexate (and many other DMARDs) would be squarely in the ā€˜empirical scienceā€™ category.

We may not really understand how they work, but they do. With of course, the caveat that you noticed yourself. Evidence is good for RA, but equivocal for PsA. So from my point of view - since they are empirically based medicines, I take an empirical approach - if it works for me, great, if it doesnā€™t, Iā€™m not going to keep banging my head against a brick wall longer than the protocol requires.

Iā€™m sorry I canā€™t be more definitive, but I googled the hell out of it when first diagnosed, and this was the best I could do. You seem to be a researcher. If you are comfortable with it, remind me what your background/ job is?

7

This is exactly the way of thinking Iā€™ve come around to. Our own personal responses and the experience we gain as time goes on count for a lot. For me Methotrexate has helped with symptoms and it also got the inflammatory markers down. It didnā€™t help much with swelling. Other trad DMARDs do diddley squat for me. The element of trial and error can be annoying but it would seem to be justified.

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