A main pillar of the treatment of rheumatic diseases is the prescription of medications. Different signs and symptoms naturally respond to medicines with different effects. For the treatment of pain, “non-steroidal” (i. e. cortisone-free) anti-inflammatory drugs (NSAIDs) are the most widely used. But “pure” painkillers such as paracetamol, metamizole or strong painkillers from the group of morphine-like substances are also used. If inflammation is considered to be the main mechanism of the disease, the use of cortisone or one of its chemical relatives (the so-called glucocorticoids) is indicated. This often improves the symptoms of the disease very quickly and can also prevent the disease from progressing. Glucocorticoids are still the most effective anti-inflammatory drugs.
Unfortunately, glucocorticoids are often not tolerated in the required dose or the side effects often outweigh the desired effects. Therefore, cortisone-sparing medications (often in combination with glucocorticoids) must be used
Since these drugs, like the glucocorticoids, have a disease-modifying effect, they are called “disease-modifying antirheumatic drugs”, abbreviated as DMARDs. In recent years, biotechnology has made massive advances in this area: whereas in the past the effect of DMARDs on rheumatic diseases was often discovered by trial and error, a better understanding of disease mechanisms and the use of biotechnological techniques such as the genetic engineering of antibodies is now possible to target disease mechanisms. DMRDs produced in this way are referred to as “biologicals” or bDMARDs, as opposed to chemically synthesized “sDMARDs”. A subset of these sDMARDs are also called “immunosuppressants” because of their profound suppressive effect on the immune system.
