But that doesn’t mean RA has to dictate how you live your life. Treatments have come a long way due to research and clinical trials, so the good news is that there are more options available than ever before. Care is often tailored to your individual needs, according to factors that include the severity of your RA, how well specific treatments work for you, any side effects experienced during treatment and your overall health history(1).
Medications are the cornerstone of rheumatoid arthritis treatment. Drugs from several classes of medications may be used to reduce disease activity, decrease or eliminate inflammation and minimize joint pain, stiffness and disability. These include the following drug types:
Conventional Disease-Modifying Antirheumatic Drugs (DMARDs)
These medications are generally the first type of drug prescribed to combat the inflammation of RA. They can slow progression of the disease and protect the joints and other tissues in the body from permanent damage caused by RA. Common DMARDs used in treatment include methotrexate, leflunomide, hydroxychloroquine and sulfasalazine.
Methotrexate is often the initial DMARD drug used in treatment, but for many RA patients, this drug alone is not enough to provide adequate control of the disease. If this is the case for you, your doctor may then try another DMARD, or may use several in combination to reduce disease activity, including inflammation and joint damage.
DMARDs can have side effects. These may include rashes, gastrointestinal upset, mouth sores, hair loss and sensitivity to sunlight. Liver damage is a possibility with some DMARDs –methotrexate and leflunomide – so regular liver function testing is necessary with their use. Additionally, there is a risk of severe birth defects with use of methotrexate and/or leflunomide, so birth control is recommended for both men and women using these drugs.
Biologics–or biologic response modifiers–are a newer, more advanced class of DMARDs, and are typically used as a step up in treatment for patients in whom conventional DMARDs are not providing adequate RA control. They work to reduce specific aspects of immune system function that trigger inflammation. Commonly used biologics are adalimumab, etanercept, and infliximab. Other approved biologics include abatacept, anakinra, certolizumab, golimumab, rituximab, tocilizumab and tofacitinib.
These drugs may be used alone or in conjunction with conventional DMARDs, and often work more quickly and effectively in reducing disease activity than DMARDs alone. Since biologics work by inhibiting some functions of the immune system, they should not be used in people with serious infections, and they are not recommended for patients who have lymphoma or have had it in the past.
These drugs, often referred to simply as steroids, act quickly to reduce RA-related inflammation and pain. Commonly prescribed drugs in this class include prednisone and prednisolone. These are often given at low doses and for a short time for the treatment of RA flares. Side effects may include increased risk of infection, diabetes, bone loss and/or osteoporosis. Also, weight gain is often an issue with use of corticosteroids.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
These drugs can aid in alleviating pain and inflammation. Some are available over-the-counter, including ibuprofen and naproxen, while other, stronger NSAIDs are available by prescription. Potential side effects of these medications include stomach irritation, liver or kidney damage and increased risk of heart disease.
The important thing to remember is that in most cases, people living with RA can live full, productive lives. The right treatment may take some trial and error, but as stated above, the treatments available are more abundant than ever. The most important thing you can do is to speak with your doctor to find the treatments that are right for you … or to let them know if they are not working for you. Additionally, researchers are continually searching for better ways to diagnose, prevent and treat arthritis through clinical trials. Your doctor may also be able to provide you with more information on what is available if you are interested in exploring this avenue.