Allopathic anti arthritis drugs– bad cop or good cop?


Whenever a patient with an autoimmune disease (Rheumatoid arthritis,Ankylosing spondylitis, Lupus) on DMARDs (Disease Modifying Anti rheumatic drugs like Methotrexate, Leflunomide) or biologics gets an infection, the DMARDs/ biologics are always blamed. The patient tends to get into a reflective mode thinking whether these drugs should have been prescribed in the first place.

What exactly happens in an autoimmune ailment is that the self immunity, that is actually meant to protect the body; instead starts attacking the body joints & organs. It, in fact, starts behaving like a bad cop. The bad cops; instead of protecting the city, start robbing its own citizens.

DMARDs/ biologics suppress the immunity & do not let the immunity attack the self organs. This is akin to locking the bad cop for what he is doing (mind you there are not one but too many bad cops in autoimmune ailments). Now, when the city cops themselves are in jail, it is a difficult situation when real robbers actually arrive. There are not many good cops to protect it. Robbers then have an easy task set out.

This is exactly what happens when an infection strikes. The immunity that is suppressed by DMARDs/ biologics is not able to mount a strong response. However, as you must have understood, blaming them is not the solution.

It is always a tight rope walk for all the Rheumatologists to keep the disease activity under check with DMARDs/ biologics & avoid too much of an immunosupression at the same time.

So, when on DMARDs/ biologics:

1. In case of any fever/ infection, contact your Rheumatologist immediately.
2. In case of any fever/ infection, stop the DMARDs/ biologics immediately & seek Rheumatologist’s opinion.

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6 Responses to Allopathic anti arthritis drugs– bad cop or good cop?

  1. Raghuvir K Trifale says:

    Thanks a lot for clarifying the technical information in very simple language.One should follow the suggestions in self interest.


  2. Ravindra pawar says:

    Very nice information… It’s always best for patient to follow doctor’s instructions properly….


  3. Purba says:

    Thanks for the post. This question always arises in my mind that whether DMARDs can weaken our immunity system.
    But Doc, if we successfully completed the treatment(with the proper guidance of a rheumatologist) and we stopped taking the DMARDs, then how our immunity system will react on that.

    And also by considering rheumatologists’ busy schedule it is difficult to consult a rheumatologist every time we catch a fever/infection. So what should we do then?


    • Yes Purba.
      The DMARDs modulate/ supress the immunity. This helps in autoimmune ailments as the immune system is attacking one’s own self.

      Once the person is in persistent remission, the DMARDs are tapered & stopped. Once stopped, their immune supression effect is over in a few weeks time. The immune system can then fight any infection without any constraint.

      One shoudl consult his/ her Family Phyisician immediately if there is an infection & stop DMARDs till infection is controlled & rheumatologist consulted.


  4. Wren says:

    I love this analogy, Dr. Akerkar! You are a really good teacher–you’re doing a real service by writing this blog. Thank you! 😀


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