Psoriatic Arthritis treatments: Disease-modifying antirheumatic drugs (DMARDs)

Anakinra is a Disease modifying antirheumatic drug that belongs to the group of medicines which are known as Interleukin-1 antagonists.

How does it work?

Anakinra blocks the action of a protein called interleukin-1 (IL-1).

IL-1 is one of the substances involved in causing inflammation in the body. By blocking it, anakinra can reduce inflammation and help improve symptoms such as pain, swelling and stiffness.

Who can have anakinra?

In the UK, anakinra is licensed to treat:

• rheumatoid arthritis in adults when methotrexate alone has not worked well enough
• some rare inflammatory conditions
• Still's disease, including systemic juvenile idiopathic arthritis and adult-onset Still's disease.

Your specialist will decide whether anakinra is suitable for you.

If you have both psoriasis and psoriatic arthritis, your rheumatology team will consider both conditions when choosing treatment.

How is it used?

Anakinra is usually given as an injection under the skin once a day.

Kineret comes in a pre-filled syringe. Your healthcare professional can show you how to give the injection yourself.

The usual injection sites are:

• the front of the thighs
• the abdomen, avoiding the area around the navel.

Try to use a different area each time to help prevent soreness.

Someone else, such as a carer or healthcare professional, can give the injection if necessary.

The usual dose for rheumatoid arthritis is 100 mg once a day, but the dose can be different for other conditions.

What are the side effects?

Like all medicines, anakinra can cause side effects, although not everyone gets them.

Injection-site reactions

The most common side effect is a reaction where the injection is given.

You may notice:

• redness
• swelling
• bruising
• itching
• pain or soreness.

These reactions are usually mild and tend to be most noticeable during the first few weeks of treatment. They often become less troublesome as treatment continues.

Infections

Because anakinra affects the immune system, it can make you more likely to develop an infection.

Contact your doctor if you develop symptoms of an infection, such as a high temperature, persistent cough or feeling generally unwell.

Anakinra should not normally be started if you have an active infection.

Changes in your blood count

Anakinra can sometimes reduce the number of white blood cells that help your body fight infections.

You will normally have blood tests before treatment and regularly during treatment to check your blood count and make sure the medicine is safe for you.

Other possible side effects

Other side effects can include:

• headache
• nausea
• skin rash
• increased cholesterol levels
• changes in liver blood tests.

If you develop unusual or persistent symptoms while taking anakinra, tell your doctor or specialist nurse.

How do I get it?

Anakinra is a prescription-only medicine. Treatment is normally started and monitored by a specialist.

You will need regular appointments and blood tests to check how well the treatment is working and whether it is causing any problems.

Marketed by

Anakinra is known commercially as Kineret and is marketed in the UK by Swedish Orphan Biovitrum Ltd

Reviewed: September 2026
Version ID: 2/ANA/PAT/09/26

Azathioprine is a type of medicine called an immunosuppressant which belongs to the group of drugs known as disease modifying antirheumatic drugs. It is used to treat severe rheumatoid arthritis

How does it work?

Azathioprine reduces the activity of the immune system by interfering with the production and growth of certain cells, including some white blood cells.

This can help reduce inflammation and the immune system's attack on healthy tissues.

Azathioprine does not work immediately. It can take several weeks or months before the full benefit of treatment is seen. It can also have a steroid-sparing effect, meaning that it may sometimes allow the dose of a corticosteroid to be reduced.

Because azathioprine suppresses the immune system, it can also reduce the body's ability to fight infections. It can affect the bone marrow, which is why regular blood tests are needed during treatment.

Who can get it?

Azathioprine can be prescribed for adults and children for a number of inflammatory and autoimmune conditions.

It is not one of the main standard DMARDs recommended by NICE for routine treatment of psoriatic arthritis. However, azathioprine may be prescribed by a specialist for particular inflammatory or autoimmune conditions when they consider it appropriate.

If you have psoriatic arthritis, your rheumatology team will choose treatment according to your symptoms, the joints affected, your other health conditions and previous treatments. NICE recommends standard DMARDs for peripheral arthritis and targeted treatments when appropriate.

How is it used?

Azathioprine is usually taken as tablets or an oral liquid once or twice a day, depending on the product and the dose prescribed.

The dose is individualised according to the condition being treated, body weight, response to treatment and other factors.

Your health care professional may start with a lower dose and increase it gradually. People with liver or kidney problems, and older people, may need particular care when the dose is selected.

Regular blood tests are important while taking azathioprine. These are used to check your blood cells and liver function and to make sure the medicine is not causing harmful effects.

Your healthcare professional may also check whether you have certain genetic differences, such as TPMT or NUDT15 deficiency, which can increase the risk of serious blood-related side effects. The results can affect whether azathioprine is suitable and what dose should be used.

Do not change your dose or stop taking azathioprine without speaking to your doctor or specialist.

What are the side effects?

Azathioprine can affect the blood and immune system, so regular monitoring is important.

Contact your health care provider if you develop:

• a fever, sore throat or other signs of infection
• unusual bruising or bleeding
• unusual tiredness or weakness
• severe nausea, vomiting or diarrhoea
• yellowing of the skin or whites of the eyes
• severe abdominal pain
• a new rash or other unexplained skin changes.

Possible side effects include:

• nausea and loss of appetite, particularly when treatment is first started
• increased susceptibility to infections
• reduced numbers of white blood cells, red blood cells or platelets
• liver problems
• hair loss
• increased sensitivity to sunlight.

Long-term treatment with azathioprine can increase the risk of certain cancers, including skin cancer and lymphoma. Good protection from the sun and regular monitoring are therefore important.

If you notice a new or changing lump, mole or patch on your skin, tell your health care provider.

How do I get it?

Azathioprine is a prescription-only medicine

You will need regular blood tests while taking it. Your healthcare professional will tell you how often these are needed.

Marketed by

Azathioprine is currently available in the UK from several manufacturers as generic products. Current UK product information includes azathioprine tablets from Tillomed Laboratories Ltd and Strides Pharma UK Ltd, as well as Jayempi 10 mg/ml oral suspension, marketed by Nova Laboratories Ltd.

Reviewed: September 2026

Version ID: 2/AZA/PAT/09/26

This page is for reference only as this product is now discontinued

Chloroquine is a medicine that can affect the immune system and reduce inflammation. It has been used as a disease-modifying antirheumatic drug (DMARD) to treat conditions such as rheumatoid arthritis and lupus.

How does it work?

Chloroquine changes the way certain cells in the immune system work. This can help reduce inflammation and the symptoms caused by inflammatory diseases.

It does not work straight away. If it is being used for an inflammatory condition, it can take several weeks or months before the full benefit is seen.

Your doctor will monitor how well it is working and may stop the medicine if it is not helping enough.

Who can get it?

Chloroquine is available on prescription, but its use for inflammatory conditions is now much less common than it was in the past.

How is it used?

The dose of chloroquine depends on the reason it is being prescribed, your age and other factors.

The old information stating that 15 mL should be taken every day should not be used. Chloroquine liquid preparations have different strengths, and the dose must be prescribed carefully.

Chloroquine can be taken with or after food if it causes stomach upset.

Do not change the dose or take extra doses unless your doctor tells you to.

What are the side effects?

Like all medicines, chloroquine can cause side effects, although not everyone will experience them.

Possible side effects include:

• headache
• feeling sick or stomach upset
• skin rashes or changes in skin colour
• hair changes or hair loss
• dizziness or changes in mood
• blurred or changed vision.

Changes to your eyesight

One of the most important risks with long-term chloroquine treatment is damage to the retina at the back of the eye.

Tell your doctor promptly if you notice changes in your eyesight, such as:

• blurred vision
• difficulty seeing colours
• changes in your field of vision
• difficulty reading or seeing clearly.

You may need regular eye checks if you take chloroquine for a long period.

Other important side effects

Rarely, chloroquine can affect the blood, muscles, nerves or heart.

Seek medical advice if you develop unusual bruising or bleeding, severe muscle weakness, changes in your heartbeat, fainting or other worrying symptoms.

Chloroquine can also interact with other medicines. Always tell your doctor or pharmacist about any medicines you are taking.

How do I get it?

Chloroquine is a prescription medicine. Your doctor will decide whether it is appropriate for your particular condition and will advise you about the correct dose and monitoring.

Marketed by

Chloroquine was known commercially as Nivaquine Syrup and was marketed in the UK by Sanofi Aventis.

Reviewed: September 2026
Version ID: 2/CHL/PAT/09/26

Ciclosporin belongs to the group of drugs known as disease modifying antirheumatic drugs and it is a type of medicine called a cytotoxic antimetabolite.

Ciclosporin can also reduce inflammation in the joints. However, it is not usually one of the first-choice disease-modifying treatments for psoriatic arthritis (PsA). Your rheumatology team may consider other DMARDs or targeted treatments depending on which parts of your PsA are affected and how active your disease is.

If you have both psoriasis and psoriatic arthritis, the choice of treatment may need to take both conditions into account.

Ciclosporin can work relatively quickly, so it may sometimes be useful when psoriasis needs to be brought under control quickly.

How does it work?

Psoriatic arthritis and psoriasis are both linked to an overactive immune system.

Ciclosporin reduces the activity of some immune cells called T cells. This can reduce inflammation.

For psoriasis, this can improve redness, scaling and thickness of the skin.

For psoriatic arthritis, reducing inflammation may help with pain, swelling and stiffness in the joints. However, ciclosporin is not normally used as a first-choice treatment for PsA and it is not suitable for everyone.

Ciclosporin does not cure psoriasis or psoriatic arthritis. It controls inflammation while you are taking it.

Who can get it?

Ciclosporin is available on prescription and is normally prescribed and monitored by a specialist.

For psoriasis, it may be considered when:

• psoriasis is severe and needs treatment with a medicine that works throughout the body
• other treatments have not worked
• other treatments are not suitable
• psoriasis needs to be brought under control quickly.

If you have active psoriatic arthritis, your rheumatology team will consider which treatment is most appropriate for your joints as well as your skin.

How is it used?

Ciclosporin is usually taken twice a day. The dose is worked out according to your body weight and may be adjusted depending on how well it works and whether you have side effects.

For severe psoriasis, the usual starting dose is 2.5 mg for each kilogram of body weight each day, divided into two doses. If necessary, the dose may be increased, but should not normally exceed 5 mg/kg per day.

Ciclosporin is generally used for a limited period rather than as a long-term treatment. NICE recommends using the lowest effective dose and generally not using ciclosporin continuously for more than one year, unless the disease is severe or unstable and other treatment options cannot be used.

Monitoring while taking ciclosporin

You will need regular checks while taking ciclosporin. These usually include:

• blood pressure
• kidney function
• blood tests to check your general health, including liver function and cholesterol.

This monitoring is important because ciclosporin can affect the kidneys and increase blood pressure.

Your doctor or pharmacist will also need to know about any other medicines, supplements or herbal remedies you take because ciclosporin can interact with a number of medicines.

Do not change the dose or stop taking ciclosporin without speaking to your doctor.

What are the side effects?

Not everyone gets side effects, and some are more likely with higher doses.

Common side effects can include:

• increased blood pressure
• changes in kidney function
• headache
• trembling or shaking
• increased hair growth
• swollen or overgrown gums
• nausea, vomiting or diarrhoea
• stomach discomfort
• muscle cramps or muscle pain
• tiredness
• increased cholesterol or other fats in the blood.

Because ciclosporin reduces the activity of the immune system, you may be more likely to develop infections.

Less common but more serious side effects can affect the kidneys, liver or nervous system.

Long-term treatment with medicines that suppress the immune system can also increase the risk of some cancers, particularly certain skin cancers and lymphomas. People taking ciclosporin for psoriasis should avoid excessive unprotected exposure to sunlight and should not have PUVA or UVB treatment at the same time unless specifically advised by their specialist.

Tell your doctor if you develop an infection, unusual bruising or bleeding, a significant change in your urine, severe headache, confusion or problems with your eyesight.

How do I get it?

Ciclosporin is available only on prescription and is normally prescribed and monitored by a specialist.

Marketed by

Ciclosporin is known commercially as Neoral oral solution and is marketed in the UK by Novartis Pharmaceuticals ltd.

Reviewed: September 2026
Version ID: 2/CIC/PAT/09/26

Hydroxychloroquine is a medicine belonging to a group of medicines called disease-modifying antirheumatic drugs (DMARDs).

It is used to treat some inflammatory conditions, including rheumatoid arthritis and lupus. It is not normally used to treat psoriatic arthritis (PsA).

Hydroxychloroquine can sometimes make psoriasis worse. For this reason, it is generally avoided in people who have psoriasis or psoriatic arthritis unless a specialist feels that the benefits of treatment outweigh the risks.

If you have both psoriasis and PsA, your rheumatology team will consider both conditions when choosing your treatment.

How does it work?

Hydroxychloroquine changes the way the immune system works. It reduces some of the activity involved in inflammation.

This can help reduce symptoms such as joint pain, swelling and stiffness in conditions such as rheumatoid arthritis.

However, hydroxychloroquine does not have a usual role in treating PsA because of the risk of making psoriasis worse.

Who can get it?

Hydroxychloroquine is available on prescription.

It is licensed for adults with rheumatoid arthritis and lupus, and for some children with juvenile idiopathic arthritis and lupus. It is also used for some skin conditions that are caused or made worse by sunlight.

If you have psoriasis or PsA, tell your doctor before starting hydroxychloroquine.

How is it used?

Hydroxychloroquine is taken as tablets, usually with food or a glass of milk.

The dose depends on the condition being treated and your body weight. The recommended maximum is 6.5 mg per kilogram of ideal body weight each day, with adult doses generally being 200 mg, 300 mg or 400 mg daily depending on the product and individual circumstances.

Hydroxychloroquine does not work immediately. It can take several weeks before you notice an improvement.

For rheumatic diseases, treatment is normally stopped if there has been no improvement after six months.

Your doctor will decide the dose that is right for you. Do not change the dose yourself.

What are the side effects?

Most people do not experience serious side effects, but hydroxychloroquine can cause problems with the eyes and these need to be taken seriously.

Possible side effects include:

• nausea, stomach pain or other digestive problems
• headache or dizziness
• skin rashes or changes in skin colour
• hair loss
• muscle weakness
• changes in vision.

Eye problems

In rare cases, hydroxychloroquine can damage the retina, the light-sensitive part of the eye. The risk is greater with higher doses and longer treatment.

You should have appropriate eye monitoring while taking hydroxychloroquine. Current UK guidance recommends retinal monitoring after five years of treatment, although monitoring may be needed earlier if you have particular risk factors.

Tell your doctor promptly if you notice:

• blurred or reduced vision
• difficulty reading
• changes in your field of vision
• unusual changes in your eyesight.

Do not ignore changes in your vision.

How do I get it?

Hydroxychloroquine is a prescription-only medicine.

Current UK products include 200 mg and 300 mg hydroxychloroquine sulfate tablets.

Marketed by

Hydroxychloroquine is marketed in the UK by Sanofi Aventis and is known commercially as Plaquenil

Reviewed: September 2026
Version ID: 2/HYD/PAT/09/26

Leflunomide

Leflunomide is a disease-modifying antirheumatic drug (DMARD) used to treat moderate to severe active rheumatoid arthritis and active psoriatic arthritis in adults.

It can help reduce inflammation, pain, swelling and stiffness, and may help slow the progression of joint damage.

How does it work?

Leflunomide is an immunomodulatory medicine. It reduces the activity of certain immune cells involved in inflammation. This helps to control the overactive immune response associated with rheumatoid arthritis and psoriatic arthritis.

Because leflunomide affects the immune system, it can increase the risk of infections. Some infections may be serious. Tell your doctor if you develop an infection, or if you have symptoms such as a persistent cough, fever or feeling generally unwell.

Leflunomide is removed from the body very slowly and can remain in the blood for many months after the last dose. If necessary, a treatment called a washout procedure can be used to remove it more quickly. This may be important if a serious side effect occurs, or if pregnancy is being planned.

The effects of leflunomide are not usually noticed immediately. Improvement may begin after around 4 to 6 weeks, although the full benefit may take several months.

Who can get it?

Leflunomide is intended for adults with active rheumatoid arthritis or psoriatic arthritis.

Treatment should be started and supervised by a specialist experienced in treating these conditions. It may not be suitable for people with certain liver, kidney, blood or immune-system problems, or for those with a serious infection.

Leflunomide must not be taken during pregnancy because it may seriously harm an unborn baby. People who could become pregnant should discuss effective contraception and pregnancy planning with their healthcare professional.

How is it used?

Leflunomide is taken as tablets.

• Swallow the tablet whole with a glass of water.
• It can be taken with or without food.
• Take it at the same time each day, as prescribed.
• Do not change the dose or stop treatment without speaking to your healthcare professional.

The usual maintenance dose is 10 mg or 20 mg once daily, depending on the condition and the individual response. A loading dose may sometimes be prescribed at the start of treatment, but this is not always used because it can increase the risk of side effects.

What are the side effects?

Not everyone experiences side effects. Possible side effects include:

• Diarrhoea, nausea or other stomach and bowel problems
• Abdominal pain
• Headache
• Dizziness
• Tiredness or weakness
• Loss of appetite or weight loss
• Hair thinning or hair loss
• Dry skin or rash
• Mouth ulcers or inflammation of the mouth
• Increased blood pressure
• Changes in liver-function blood tests
• Changes in blood-cell counts
• Tingling or altered sensation in the hands or feet

Important safety information

Leflunomide can affect the liver, blood cells, lungs and immune system. Regular blood tests are needed to monitor treatment. These usually include:

• Liver-function tests
• Full blood count
• Kidney-function tests, where appropriate
• Blood-pressure checks

Contact your healthcare professional promptly if you develop:

• A sore throat, fever or repeated infections
• Unexplained bruising or bleeding
• Yellowing of the skin or eyes
• Severe or persistent diarrhoea, vomiting or weight loss
• A widespread rash, skin blistering or sores in the mouth
• A persistent cough or breathlessness
• New or worsening numbness, tingling or weakness

Seek urgent medical advice if you develop breathing difficulties, a severe skin reaction or symptoms of a serious infection.

How do I get it?

Leflunomide is available on prescription. It is usually initiated by a rheumatology specialist, with ongoing monitoring arranged through specialist care or a shared-care service.

Marketed by

Leflunomide is known commercially as Arava and is marketed in the UK by Sanofi-Aventis Ltd.

Reviewed: September 2026
Version ID: 2/LEF/PAT/09/26

Methotrexate belongs to a group of medicines known as disease-modifying antirheumatic drugs (DMARDs). It is also an antimetabolite medicine that can affect the growth and activity of cells.

Methotrexate is used to treat several conditions, including:

• Rheumatoid arthritis
• Psoriatic arthritis
• Severe psoriasis
• Juvenile idiopathic arthritis
• Some cancers
• Other inflammatory or immune-related conditions, when prescribed by a specialist

For inflammatory conditions, methotrexate helps reduce disease activity and inflammation. It is not the same as the higher-dose chemotherapy treatment used for cancer, although it is the same medicine.

How does it work?

Methotrexate reduces the activity of the immune system and helps control inflammation. In inflammatory arthritis and psoriasis, it can reduce symptoms such as pain, swelling, stiffness and skin inflammation.

The exact way it works in inflammatory conditions is not fully understood. Its effects are thought to include changes in immune-cell activity and the release of inflammatory substances.

Methotrexate does not work immediately. Some people begin to notice an improvement after several weeks, but it may take several months to achieve the full benefit.

Because methotrexate can affect healthy cells as well as cells involved in disease, it must be taken carefully and monitored regularly.

Who can have it?

Methotrexate may be prescribed for adults and children when clinically appropriate. The dose and formulation depend on the person’s age, condition, body size, kidney and liver function, and response to treatment.

It may be used for:

• Rheumatoid arthritis
• Psoriatic arthritis
• Severe psoriasis
• Juvenile idiopathic arthritis
• Certain cancers
• Other conditions requiring specialist treatment

Methotrexate may not be suitable for people with certain blood, liver, kidney or immune-system problems. It is also unsuitable during pregnancy for most indications and should not be used when breastfeeding unless specifically advised by a specialist.

Tell your doctor if you have an infection, liver disease, kidney problems, a blood disorder, a history of lung disease, or if you drink alcohol regularly. You should also tell your doctor about all medicines and supplements you take.

How is it used?

Methotrexate is available as tablets, oral liquid and injections given under the skin or, in some circumstances, into a muscle or vein.

For inflammatory conditions, methotrexate is usually taken or given once a week on the same day each week.

The dose is individualised. Treatment is often started at a low dose and adjusted according to the condition being treated, response to treatment, blood-test results and side effects.

Commonly used weekly doses for inflammatory conditions are within the range prescribed by the rheumatology or dermatology team. The maximum dose depends on the condition, formulation and clinical circumstances.

If you are using tablets or oral liquid, follow the instructions on the dispensing label carefully. Oral liquid formulations may come with a specific measuring device, which should be used to ensure the correct dose.

Methotrexate is usually prescribed with folic acid. Folic acid helps reduce some side effects, such as mouth ulcers, nausea and changes in blood-cell counts. It should be taken on the days advised by your healthcare professional.

Do not change your methotrexate or folic acid dose without speaking to your prescriber or pharmacist.

What are the side effects?

Common side effects may include:

• Feeling sick or being sick
• Stomach pain or indigestion
• Diarrhoea
• Loss of appetite
• Headache or dizziness
• Tiredness or weakness
• Mouth ulcers
• Hair thinning or hair loss
• Skin rash or increased sensitivity to sunlight

These effects may improve as your body adjusts to treatment. Tell your healthcare professional if they are troublesome or persistent.

Methotrexate can affect the blood, liver, kidneys, skin and lungs. It can also make you more susceptible to infections.

Contact your healthcare professional promptly if you develop:

• A sore throat, fever, chills or other signs of infection
• Unusual bruising or bleeding
• Severe tiredness, paleness or weakness
• Yellowing of the skin or eyes
• Persistent nausea, vomiting or loss of appetite
• Severe abdominal pain
• A new or worsening skin rash
• Mouth or throat ulcers
• Changes in urination

Methotrexate can rarely cause inflammation or scarring of the lungs. Seek urgent medical advice if you develop a persistent dry cough, chest pain, difficulty breathing or unexplained breathlessness.

Seek urgent medical attention if you develop severe breathing difficulties, facial or tongue swelling, a severe skin reaction, coughing or vomiting blood, black stools, or other symptoms that suggest a serious reaction.

Monitoring

Regular blood tests are essential during methotrexate treatment. These usually monitor:

• Full blood count
• Liver function
• Kidney function

The tests are needed more frequently when treatment is first started or when the dose is changed. Once treatment is stable, monitoring may be less frequent, according to the schedule advised by your healthcare team.

You should not miss monitoring appointments. Treatment may need to be paused or stopped if blood-test results are abnormal or if serious side effects develop.

Avoid excessive alcohol because it may increase the risk of liver damage. Check with your healthcare professional before having vaccinations, particularly live vaccines.

Pregnancy, contraception and fertility

Methotrexate can cause serious harm to an unborn baby and must not normally be used during pregnancy.

People who could become pregnant should discuss effective contraception and pregnancy planning with their healthcare team. Men and women should follow the contraception advice provided for their particular treatment.

If you become pregnant while taking methotrexate, contact your specialist team promptly for advice. Do not stop prescribed treatment without medical guidance unless instructed to do so.

Methotrexate may temporarily affect sperm production. Discuss fertility and family-planning plans with your specialist before starting treatment.

How do I get methotrexate?

Methotrexate is available only on prescription. It is usually started and monitored by a rheumatology, dermatology, paediatric or other specialist team, although ongoing prescribing and monitoring may be shared with primary care.

Methotrexate is known commercially as Jylamvo which is marketed in the UK by Intrapharm, Maxtrex which is marketed in the UK by Pfizer Ltd, Methofill which is marketed in the UK by Accord,  Methotrexate oral solution which is marketed in the UK by Rosemont Pharmaceuticals Limited,  Metoject which is marketed in the UK by Medac, Nordimet which is marketed in the UK by Nordic and Ziatal which is marketed in the UK by Nordic.

Reviewed: September 2026
Version ID: 2/MET/PAT/09/26

Penicillamine is a medicine that belongs to a group of drugs called disease-modifying antirheumatic drugs (DMARDs). It has historically been used to treat severe, active rheumatoid arthritis when other treatments have not worked or have not been tolerated.

How does it work?

Penicillamine has different actions depending on the condition being treated.

In rheumatoid arthritis, it helps reduce abnormal immune activity and inflammation. This may improve symptoms such as joint pain, swelling and stiffness. It works slowly and may take several months before the full benefit is noticed.

Penicillamine can also bind to certain metals, including copper and lead. This process, called chelation, helps the body remove these metals when treatment is medically necessary.

Who can have it?

Penicillamine may be prescribed for selected adults and children by a specialist. The appropriate age and dose depend on the condition being treated.

Before treatment, your doctor will assess your medical history and may arrange blood and urine tests. Penicillamine may not be suitable for people with certain kidney, blood, liver or immune-system problems, or for those who have previously had a serious reaction to the medicine.

Tell your doctor if you are pregnant, planning a pregnancy or breastfeeding, or if you take other medicines or supplements.

How is it used?

Penicillamine is taken by mouth as tablets or capsules, depending on the product available.

The dose varies considerably according to the condition being treated. For rheumatoid arthritis, treatment is usually started at a low dose and increased gradually under medical supervision. The dose may then be adjusted according to response and side effects.

It may take several months to assess whether the medicine is helping. Do not increase, reduce or stop the dose without speaking to your prescriber.

Penicillamine is often taken on an empty stomach, as directed by the prescriber or pharmacist. It may need to be taken separately from certain medicines, minerals or supplements because these can affect its absorption.

What are the side effects?

Possible side effects include:

• Feeling sick or being sick, particularly when treatment begins
• Loss of appetite
• Changes in taste or loss of taste
• Diarrhoea or stomach discomfort
• Skin rash, redness or itching
• Hair loss
• Mouth ulcers
• Fever or frequent infections
• Bruising or unexpected bleeding
• Muscle weakness
• Worsening joint pain or swelling

Penicillamine can sometimes affect the kidneys, liver or blood cells. Protein or blood in the urine may be detected during urine testing and may require treatment to be paused or stopped.

Rare but serious side effects can include:

• Severe blood disorders
• Kidney inflammation or other kidney problems
• Liver problems, including jaundice
• Lung inflammation or breathing difficulties
• Severe skin reactions
• Serious muscle or nerve problems

Contact your healthcare professional promptly if you develop a sore throat, fever, frequent infections, unusual bruising or bleeding, severe weakness, changes in your urine, yellowing of the skin or eyes, or a new or worsening rash.

Seek urgent medical advice if you develop difficulty breathing, facial swelling, blistering or peeling skin, or other symptoms of a serious allergic or skin reaction.

Monitoring

Regular blood and urine tests are needed, particularly when treatment is started and when the dose is increased. These tests help monitor:

• Blood-cell counts
• Kidney function
• Liver function
• Protein or blood in the urine

Your healthcare team will advise how often monitoring is required. Treatment may need to be interrupted or stopped if test results are abnormal or serious side effects develop.

How do I get penicillamine?

Penicillamine is available only on prescription.

Marketed by

Penicillamine is known commercially as Distamine and is marketed in the UK by Alliance Pharmaceuticals Ltd.

Reviewed: September 2026
Version ID: 2/PEN/PAT/09/26

Sodium aurothiomalate is a disease-modifying antirheumatic drug (DMARD) containing gold. It has historically been used to treat inflammatory arthritis, particularly rheumatoid arthritis and juvenile idiopathic arthritis.

Its use has declined because other DMARDs are generally preferred and may be more suitable. Sodium aurothiomalate is not normally used to treat psoriasis or psoriatic arthritis.

How does it work?

Sodium aurothiomalate helps reduce inflammation and may improve symptoms such as joint pain, swelling and stiffness. It works gradually and may take several months before a noticeable improvement is seen.

It does not provide immediate pain relief and is not suitable for treating sudden flares without other treatment.

Who can have it?

Sodium aurothiomalate may be considered by a specialist for selected people with inflammatory arthritis when other treatments are unsuitable or have not worked.

It may not be suitable for people with certain blood, kidney, liver or skin conditions, or for those who have previously had a serious reaction to gold treatment. Your doctor will assess your medical history and arrange appropriate tests before treatment.

It is not routinely recommended simply because someone is older. Suitability depends on the person’s overall health, other medicines and the risks and benefits of treatment.

How is it used?

Sodium aurothiomalate is given as an injection, usually into a muscle by a healthcare professional.

Treatment generally begins with a small test dose to check for an adverse reaction. If this is tolerated, the dose may be increased according to the prescribed treatment schedule.

You may be observed for a period after an injection, particularly during the early stages of treatment. Your healthcare professional will explain what to expect.

Regular monitoring is essential. Blood tests, urine tests and checks for skin reactions may be carried out before and during treatment.

What are the side effects?

Possible side effects include:

• Skin rashes, itching or inflammation
• Mouth ulcers or irritation in the mouth and throat
• A metallic taste
• Diarrhoea or other digestive problems
• Bruising or unexpected bleeding
• Changes in the menstrual cycle
• Changes in blood-cell counts
• Protein in the urine, which may indicate kidney problems

Some side effects may require treatment to be paused or stopped.

Contact your healthcare professional promptly if you develop a rash, mouth ulcers, a sore throat, fever, unusual bruising or bleeding, persistent diarrhoea, or changes in the amount or appearance of your urine.

Seek urgent medical advice if you develop a severe skin reaction, breathing difficulties, facial swelling or other symptoms suggesting a serious allergic reaction.

Monitoring

Sodium aurothiomalate can affect the blood, kidneys and skin. Regular blood and urine tests are therefore needed throughout treatment.

Your healthcare professional may advise delaying or stopping an injection if test results are abnormal or if you develop symptoms that could indicate a serious side effect.

How do I get sodium aurothiomalate?

Sodium aurothiomalate is available only on prescription and is administered by a healthcare professional, usually under the supervision of a rheumatology team.

Marketed by

It is known commercially as Myocrisin and is marketed in the UK by Sanofi Aventis.

Reviewed: September 2026
Version ID: 2/SOA/PAT/09/26

Sulfasalazine is a disease-modifying antirheumatic drug (DMARD). It is used to treat inflammatory arthritis, including rheumatoid arthritis and some forms of psoriatic arthritis (PsA).

It can help reduce inflammation, pain, swelling and stiffness. It is also used to treat certain bowel conditions, such as ulcerative colitis and Crohn’s disease.

Sulfasalazine is one of the standard DMARDs that may be considered for people with peripheral psoriatic arthritis, particularly when joints in the arms, hands, legs or feet are affected. It is not usually helpful for inflammation affecting the spine alone.

How does it work?

Sulfasalazine helps reduce the activity of the immune system and limits the inflammation that causes symptoms.

It does not work immediately. Some people begin to notice an improvement after around six weeks, although it may take several months to achieve the full benefit.

If it is not helping enough after a suitable trial, your doctor may recommend changing the dose, trying another DMARD or adding another treatment.

Who can have it?

Sulfasalazine can be prescribed for adults and, in some circumstances, children.

It may be considered for people with:

• rheumatoid arthritis
• peripheral psoriatic arthritis
• some other inflammatory arthritis conditions
• ulcerative colitis or Crohn’s disease.

It may not be suitable for people who are allergic to sulfasalazine, sulfonamides or salicylates, or for people with certain blood, liver or kidney problems.

Your doctor will check your medical history and may arrange blood tests before treatment begins.

How is it used?

Sulfasalazine is usually taken as tablets. It is also available in some liquid and other formulations.

Treatment is normally started at a low dose, which is gradually increased. This helps reduce the chance of side effects.

For inflammatory arthritis, the dose is adjusted according to how well the medicine works and how well it is tolerated. A commonly used maximum dose is 3,000 mg per day, taken in divided doses, although the dose prescribed for you may be lower.

Some tablets, such as Salazopyrin EN-Tabs, have a special coating. They should be swallowed whole and should not be crushed or chewed.

Take sulfasalazine with or after food if advised, and drink plenty of fluids during treatment.

Always follow the dose given by your doctor or pharmacist.

What are the side effects?

Like all medicines, sulfasalazine can cause side effects, although not everyone will experience them.

Common side effects include:

• nausea or feeling sick
• stomach discomfort
• loss of appetite
• headache
• dizziness
• skin rash
• fever
• hair thinning or hair loss.

These effects may improve as your body adjusts to the medicine. If they continue or are troublesome, speak to your doctor or pharmacist. Sometimes reducing the dose temporarily can help.

Blood tests and infections

Sulfasalazine can occasionally affect the blood, liver or kidneys. You will therefore need regular blood tests, particularly during the first few months of treatment.

Contact your doctor promptly if you develop:

• a sore throat
• a high temperature
• an unexplained infection
• unusual tiredness or paleness
• unexplained bruising or bleeding
• yellowing of the skin or eyes
• a new or spreading rash.

These symptoms can sometimes indicate a problem with the blood, liver or an allergic reaction. Your doctor may advise you to stop taking sulfasalazine while the cause is investigated.

Sulfasalazine can also cause increased sensitivity to sunlight. Use suitable sun protection and seek medical advice if you develop a severe rash, blistering or peeling skin.

Fertility and pregnancy

Sulfasalazine can temporarily reduce sperm count and cause infertility in some men. This effect is usually reversible, and fertility generally returns after treatment is stopped, often within a few months.

If you are planning a pregnancy, discuss this with your doctor. Sulfasalazine can affect folic acid absorption, so your doctor may recommend taking folic acid.

Do not stop treatment or make changes to your medication without medical advice.

How do I get sulfasalazine?

Sulfasalazine is a prescription-only medicine.

Your doctor or rheumatology team will monitor your progress and arrange regular blood tests to check that the medicine remains suitable for you.

Marketed by

Sulfasalazine is available under several names, including Salazopyrin EN-Tabs.

Salazopyrin EN-Tabs is marketed in the UK by Pfizer Limited.

Reviewed: September 2026
Version ID: 2/SUL/PAT/09/26