Alternatives to plaquenil for rheumatoid arthritis

Rheumatoid Arthritis Drugs: Pros and Cons

If there’s any comfort in having rheumatoid arthritis these days, it’s that there’s a growing number of drugs to deal with its symptoms.

Not only can some medications help manage the inflammation, pain, and symptoms of rheumatoid arthritis, but they can stop or slow the progression of the disease, too.

Traditionally, rheumatoid arthritis treatments have included a combination of DMARDs, or disease modifying anti-rheumatic drugs, that now include different forms of biologics and two other classes of medications: non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids.

Treatment guidelines from the American College of Rheumatology (ACR) state that early aggressive treatment is the best way to prevent irreversible joint damage and to maintain quality of life for people with rheumatoid arthritis.

Doctors who treat rheumatoid arthritis now have more drugs to use, and they are using them earlier.

NSAIDs

This class of drugs includes over-the-counter medications such as aspirin, Advil (ibuprofen), and Aleve (naproxen), as well as prescription-strength drugs like Naprelan (naproxen sodium). Researchers have been examining the effects of NSAIDs, and a study of more than 24,000 people published in December 2016 in The New England Journal of Medicine compared the effectiveness and safety of three of them: ibuprofen, naproxen, and Celebrex (celecoxib). The study enrolled people diagnosed with both osteoarthritis and rheumatoid arthritis who were also at high risk for heart disease. Participants were split into three groups, and were given one of the three drugs for an average of 20 months.

Researchers examined several complications from these drugs, including stomach ulcers and kidney problems. “In the RA group, all three NSAIDs had similar cardiovascular, GI, and renal events except for overall mortality, where naproxen in the RA group had a higher rate of overall mortality compared to Celebrex and ibuprofen,” says M. Elaine Husni, MD, MPH, an author of the study and vice chair of rheumatology at the Cleveland Clinic in Ohio. “The results offer clinicians increased detail on how to monitor patients who take chronic NSAIDs with a more individualistic approach.”

Pros: NSAIDs reduce joint inflammation, pain, and fever.

Cons: They have no effect on the eventual progression of the disease, can irritate the lining of the stomach, and can damage the kidneys when used at high doses for extended periods of time. Additionally, in July 2015, the Food and Drug Administration (FDA) strengthened the warning that NSAID use can increase your chance of having a heart attack or stroke. Risk occurs as early as the first few weeks after initiating therapy, and rises with higher doses of NSAIDs. While anyone can be at risk, the threat is higher for people with underlying cardiac disease.

“For patients with pre-existing cardiac disease and patients who smoke, risk-benefit discussions need to reflect this heightened awareness of the cardiovascular risk of NSAIDs,” says Susan Goodman, MD, an associate professor of medicine at Weill Cornell Medical College and a rheumatologist at the Hospital for Special Surgery in New York City.

DMARDs

Treatment guidelines from the ACR state that everyone with RA should be started on at least one DMARD at the beginning of treatment, and that people with more disease activity and features of poor prognosis should be started on — or considered for — two or more DMARDs. The guidelines also say that if you’re started on one DMARD and aren’t doing well after three months, then another DMARD should be added. Commonly used DMARDs include Rheumatrex and Trexall (methotrexate sodum), Plaquenil (hydroxychloroquine sulfate), Arava (leflunomide) and Azulfidine (sulfasalazine).

Pros: DMARDs not only help control symptoms, but they can also minimize joint damage and stave off future complications. “The advantage of DMARDs is that they’ve been in use for years, so rheumatologists are very well-versed in the best ways to assess a patient’s response and benefit, and are very experienced in monitoring side effects,” Dr. Goodman says.

Cons: Doctors must monitor your blood work and symptoms closely while you’re taking DMARDs, and the benefits of DMARDs may take weeks or months to take effect. Side effects of methotrexate include liver damage, lung damage, and a decreased ability to fight off infections. Eye damage can be a side effect of hydroxychloroquine. Sulfasalazine may cause allergic reaction if you are sensitive to sulfa drugs, and leflunomide has been associated with birth defects when taken during pregnancy.

Because of an increased risk for infection while taking a DMARD, the ACR guidelines suggest getting vaccinated for pneumococcus, influenza, hepatitis B, human papillomavirus (HPV), and herpes zoster (shingles) before starting treatment. If you’re already on a DMARD, talk to your doctor about what vaccines you may need.

Biologics

These drugs are targeted DMARDs that turn down your body’s immune response. They can reduce joint pain and swelling, as well as reduce long-term damage. The two basic types are anti-tumor necrosis factor inhibitor (anti-TNF) drugs and non-TNF drugs.

Anti-TNF medications work by blocking the effects of TNF — a protein that encourages inflammation and revs up the immune system — thereby decreasing the joint inflammation that is a hallmark of rheumatoid arthritis.

The ACR guidelines recommend starting an anti-TNF drug with or without methotrexate if you have high disease activity and poor prognostic features in early rheumatoid arthritis. If you’ve been started on DMARD therapy and have moderate to high disease activity after three months, your doctor may add or switch to an anti-TNF.

If you’re taking an anti-TNF already and you’re not doing well after three months, your doctor may switch you to another anti-TNF or to a non-TNF biologic. Anti-TNF drugs include Enbrel (etanercept), Remicade (infliximab), and Humira (adalimumab). Non-TNF biologics include abatacept, rituximab, and tocilizumab.

Pros: Biologic medications are effective in controlling symptoms and preventing complications of rheumatoid arthritis. “The major advantages of the biologics are the fast onset of action and high rate of response,” Goodman says.

Cons: They can cause several potentially life-threatening side effects. Because these drugs interfere with the immune system, they increase your risk for infection, including tuberculosis, so the ACR guidelines recommend screening for tuberculosis if you’re taking biologics. Additionally, some of these medications have been linked to the development of lymphoma, a cancer of the white blood cells. Biologics are given by injection, and one of the most common side effects is burning, itching, and swelling at the site of the injection. You should not take a biologic if you have untreated chronic hepatitis B, have had a cancer tumor in the past five years, or have severe heart failure. Vaccination recommendations for biologics are similar to those for DMARDs, so you should talk to your doctor about them.

Janus Kinase (JAK) Inhibitors

JAK inhibitors are the latest RA medications, Goodman says. This new class of biologic DMARDs specifically targets JAK enzymes involved in inflammation. Because they’re given in pill form, they’re sometimes called oral biologics. Xeljanz (tofacitinib) was the first of these drugs to get FDA approval for adults with moderate to severe RA.

Pros: This medication is effective for people who haven’t seen results with methotrexate or can’t take that drug.

Cons: As with other biologics, tofacitinib affects the immune system and can leave you vulnerable to serious infections, such as tuberculosis, as well as certain cancers. An increase in cholesterol and liver enzymes is also a risk.

Corticosteroids

Corticosteroid drugs help fight inflammation and depress your immune response. Steroid drugs include prednisone and Solu-Medrol (methylprednisolone). Steroids are used to control rheumatoid arthritis symptoms, but they do not alter the course of the disease in the same way that DMARDs do.

Pros: They can be given by mouth, intravenously, or be injected directly into a joint. Because steroids act quickly, they can be used while waiting for other drugs like DMARDs to take effect. They are useful for a sudden flare of symptoms.

Cons: Steroid use is limited because they can lead to a host of side effects, including weight gain, high blood pressure, elevated blood sugar, osteoporosis, and mood disturbances.

RA treatment isn’t one-size-fits-all. Work closely with your doctor to find the best treatment or treatment combination for you. The benefits of treatment typically outweigh the side effects, but it’s good to know what to look for.

Additional reporting by Mikel Theobald.

Why I Chose HUMIRA

On Screen:

Wondering how patients decided on HUMIRA?
We’ve Been There

On Screen:

HUMIRA Use for Crohn’s Disease

HUMIRA is a prescription medicine used to reduce signs and symptoms, and to achieve and maintain clinical remission in adults with moderate to severe Crohn’s disease who have not responded well to certain other medications. HUMIRA is also used to reduce signs and symptoms and achieve clinical remission in these adults who have also lost response to or are unable to tolerate infliximab.

HUMIRA Use for Ulcerative Colitis

HUMIRA is a prescription medicine used in adults to help get moderate to severe ulcerative colitis under control (induce remission) and keep it under control (sustain remission) when certain other medicines have not worked well enough. It is not known if HUMIRA is effective in people who stopped responding to or could not tolerate anti-TNF medicines.

Individual results may vary.

On Screen:

Joey
Moderate to Severe Crohn’s Disease Patient

Joey:
I was very appreciative of talking with my gastroenterologist about all the options that I had for biologics.

On Screen:

Sarah
Moderate to Severe Ulcerative Colitis Patient

Sarah:
We did sit down and we weighed the pros and cons, obviously, with taking HUMIRA.

On Screen:

Melissa
Moderate to Severe Crohn’s Disease Patient

Melissa:
My doctor gave me a lot of different options to choose from, and after discussing all of them in depth, we together decided that HUMIRA was going to be the best option for me.

On Screen:

Mark
Moderate to Severe Crohn’s Disease Patient

Interviewer (from off screen):
Was there something specific about HUMIRA that led you to try it?

Mark:
Being able to inject at home was a huge positive for me.

Joey:
Hearing that HUMIRA had, you know, been around for a while, made me really confident in picking that as a medication.

On Screen:

Lauren
Moderate to Severe Crohn’s Disease Patient

Lauren:
I didn’t want to have to go into the office frequently; my doctor’s an hour away and that was a big concern for me.

Melissa:
My doctor informed me of all the risks of HUMIRA, along with the possibility of obtaining remission.

On Screen:

Maria
Moderate to Severe Ulcerative Colitis Patient

Maria:
I was really focusing on the possibilities of symptom control.

Sarah:
I chose HUMIRA because of the possibility that I could feel better and could be an active participant in my life. HUMIRA has helped me get into remission and stay in remission.

Mark:
Finding out that it had been around for a while really made me feel a lot more comfortable before I took it.

On Screen and Voiceover:

SAFETY CONSIDERATIONS
Serious infections have happened in people taking HUMIRA. These serious infections include tuberculosis (TB) and infections caused by viruses, fungi, or bacteria that have spread throughout the body. Some people have died from these infections. HUMIRA may increase the chance of getting lymphoma, including a rare kind, or other cancers. HUMIRA can cause serious side effects including hepatitis B infection in carriers of the virus, allergic reactions, nervous system problems, blood problems, heart failure, certain immune reactions including a lupus-like syndrome, liver problems, and new or worsening psoriasis.

Please see additional Important Safety Information on this web page.

On Screen:

Learn more from real patients and their experiences.
Watch the next video now >>

Humira Side Effects, Complications and Interactions

Humira (adalimumab) is the best selling drug (in dollars) in the U.S. (and around the world). Sales were listed between $13 and $16 billion in 2016. That is an unbelievable amount of money for a single medication. To put it into perspective, the first billion dollar drug in America was Tagamet (cimetidine) for ulcers. In 1987 people considered its sales of of $1.13 billion unprecedented. Physicians prescribed Tagamet for a wide range of digestive disorders affecting millions of people.

Humira: Huge Sales Despite Orphan Status:

It’s not because so many people take Humira that it earns so much money. Humira is categorized as an orphan drug to treat juvenile rheumatoid arthritis, Crohn’s disease and uveitis (a severe inflammatory eye disease). Orphan status provides special perks to drug companies ().

Orphan drugs were once considered unprofitable. The Oxford American Dictionary defines an orphan drug as “a pharmaceutical that remains commercially undeveloped owing to limited potential for profitability.” The FDA originally considered such medications as “significant drugs of limited commercial value.” Clearly, that is not the case for Humira.

A carton with two prefilled syringe “pens” of Humira can cost over $4,500. At that price it is easy to understand how the sales of this injectable medication have soared. People generally get an injection every other week (two shots a month).

Other “indications” for Humira include rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and moderate-to-severe ulcerative colitis. Many people consider Humira a miracle. Others see Humira side effects as worrisome. We’re going to provide the pros and cons so you can determine the benefit/risk ratio for yourself.

TNF (Tissue Necrosis Factor) and Your Immune System:

When your immune system detects something out of whack in your body it activates compounds designated tumor necrosis factors (TNFs). Whether it is a bacterial infection or a viral invasion, TNF is created to fight off the foreign invaders. If you come down with the flu your body will make TNF as one of the first lines of defense to combat the virus (Journal of Virology, Feb., 2002).

If “tumor” and “necrosis” caught your attention you are also on target. Necrosis comes from the greek word nekrosis, which means “becoming dead” or the death of cells or tissues. In other words, tumor necrosis factor has anti-tumor activity and may play a key role in cancer detection and therapy (Oncotarget, Oct., 2011; Chemical and Pharmaceutical Bulletin, online, July 14, 2017).

The First TNF Blockers: Enbrel, Remicade and Humira

First came Enbrel (etanercept) in 1998. It was designated a “biological” drug in that it was created by utilizing human DNA transplanted into ovarian cells of hamsters. This led to the creation of proteins that had been genetically engineered. It was called a TNF-inhibiting drug in that it grabs onto tissue necrosis factor. Remicade (infliximab) came next in 1999. This monoclonal antibody (“mab“) blocks tissue necrosis factor-alpha. Humira arrived in 2002.

These drugs have been especially helpful for autoimmune conditions like rheumatoid arthritis. When traditional medications (DMARDs or disease-modifying anti-rheumatic drugs) don’t do the job, doctors often turn to the TNF blockers.

Sarah in the United Kingdom shares this experience with Humira:

“I’ve had rheumatoid arthritis for nine years. It’s been incredibly painful. I write for a living so I need my hands to function. I’ve managed to hold down a job even though during the worst flares my hands were bent and looked like claws.

“Two years ago numerous medications had done nothing to relieve the RA. After 10 months on prednisolone, which worked for RA, but caused all sorts of other horror, I started on Humira (adalimumab). It’s completely changed my life. 99% of the time you’d never even know I had RA. Flares are practically unheard of. My hands look completely normal and no longer like claws. Even the fatigue has pretty much abated. And I’ve suffered absolutely no side effects.

“All in all, for me, it’s been a miracle cure. I know the US medical system is poles apart from the UK and that Humira is very expensive there. It gave me my life back.”

Not surprisingly, such stories have stoked sales of drugs like Humira. That is why these are billion-dollar bonanzas for the drug companies. But not everyone experiences such success without complications.

Humira Side Effects:

The first thing you discover when you look at the official prescribing information for Humira (adalimumab) is a black box titled:

WARNING: SERIOUS INFECTIONS AND MALIGNANCY

“Patients treated with HUMIRA are at increased risk for developing serious infections that may lead to hospitalization or death.”

Doctors are warned about “reactivation of latent TB” and “invasive fungal infections, including histoplasmosis, coccidioidomycosis, candidiasis, aspergillosis, blastomycosis, and pneumocystosis.” These are not easy infections to overcome. In addition, the black box warning lists

“bacterial, viral and other infections due to opportunistic pathogens, including Legionella and Listeria.”

Physicians are encouraged to “monitor patients closely for the development of signs and symptoms of infection during and after treatment with HUMIRA…”

A systematic review published in Expert Opinion on Drug Safety (Dec., 2016) concluded that:

“Our study encompassed data from 71 randomized controlled trials involving 22,760 participants and seven open label extension studies with 2,236 participants. Quantitative synthesis of the available data found statistically significant increases in the occurrence of any infections (20%), serious infections (40%), and tuberculosis (250%) associated with anti-TNF drug use, while the data for opportunistic infections were scarce.”

MALIGNANCY (from the FDA’s black box warning)

“Lymphoma and other malignancies, some fatal, have been reported in children and adolescent patients treated with TNF blockers including HUMIRA.”

Despite these ominous FDA-mandated warnings, the science linking TNF blockers to cancer remains controversial. One overview (Expert Opinion on Drug Safety, Dec. 2016) concluded:

“There was no evidence of an association between anti-TNF agents and cancer risk…We found evidence of selective outcome reporting or publication bias suggesting that the pooled effect estimate for cancer may have been overestimated.”

It remains to be seen whether the risk of lymphoma or other malignancies will show up in coming years as people have longer exposures to these TNF-inhibiting drugs.

Other Humira Side Effects:

  • Injection Site Reactions: because these drugs are delivered by shot, the complications in that area include redness, itching, pain, swelling and/or bleeding.
  • Serious Infections: pneumonia, septic arthritis, prosthetic and post-surgical infections, cellulitis, diverticulitis and pyelonephritis.
  • Liver enzyme elevations: liver damage
  • Upper Respiratory tract infections: sinusitis, flu-like symptoms
  • Digestive tract distress: nausea, stomach pain
  • Blood lipid changes: elevations in blood cholesterol
  • Headache
  • Rash
  • Back pain, pain in other extremities
  • Urinary tract infections
  • High blood pressure
  • Bone pain, muscle cramps, tendon disorders
  • Blood in the urine
  • Cancers: lymphoma, leukemias, skin cancer
  • Severe allergic reactions (anaphylaxis)
  • Heart failure, irregular heart rhythms
  • Autoimmune disorders (lupus-like syndrome, sarcoidosis)

Stories from Readers about Humira Side Effects:

A long list of Humira side effects is virtually meaningless to health professionals and patients alike. That’s because most people zone out after the first few words. They assume that none of those nasty complications could possibly apply to them. Here are some real-world experiences from visitors to this website:

Muddy in Alabama writes:

“I have had two shots of Humira every other week. I have been so sick that I was in the emergency room. All they could say was it was due to the Humira. I just wondered what damage it has done to my body? I am more sick now than with RA. No more Humira for me.”

Deloris shared this reaction after various biologics:

“I was diagnosed with RA two and half years ago. The moderate pain and joint destruction have remained the same throughout that time. I’ve taken methotrexate and prednisone since the onset, and my rheumatologist has tried many biologics to get my disease under control. The first was Cimzia.

“After only 3 doses, I stopped it due to sudden and severe muscle pain. TNF blockers are not to be given to people with MS, which I don’t have. However, I have permanent muscle and nerve damage from taking simvastatin, a cholesterol-lowering drug. I have enough muscle pain already. I don’t need any new agony presented by a TNF blocker.”

Hillary in Florida adds this note of caution:

“I have been taking Enbrel since 1998 for RA. It did give me a better life, with less pain. I was told of the risks, but when you have severe pain, you’ll deal with it.

“Forward to 2015. After a routine mammogram and further tests, I was diagnosed with CLL, Chronic Lymphocytic Leukemia. What a shock. But the doctor said it is a slow cancer, with no real cure. So treatment is ‘watch & wait.’ I have no symptoms and refused to stop Enbrel.

“I have also had a major issue with wound healing after a TAR revision in 2015. This could be due to Enbrel and/or CLL.”

“It’s a terrible position to be in. Without Enbrel, I’d be in severe pain. But now I have CLL and healing issues.”

Cathy in North Carolina shared this infection reaction:

“I have been on Remicade for two years for ulcerative colitis (UC). I try to avoid being around people who are sick. I have had two colds that evolved into double ear infections and had to go on antibiotics each time.

“If I get sick, it takes about four weeks to get over. Because I had breast cancer 12 years ago I still see a medical oncologist. She and I talk about the lymphoma risk. I have had UC for 30 years and feel fortunate to not have had to go on more aggressive therapy until now.”

Kay had to take prednisone to overcome Humira side effects:

“In 2015 I was hospitalized for three days following a terrible reaction to Humira. I received IV prednisone over those three days which eliminated the spinal and brain inflammation caused by the Humira.”

Bob had a terrible skin rash from a TNF blocker:

“I took my first Humira shot and one week later I woke up with whole body rash. This rash progressed on me for two days. It itched and burned and it made its way on to my face giving me a butterfly rash. The slightest amount of sun was burning like I had a bad sunburn. I went to the ER at 1:30 am and they didn’t know what to do so they told me to take Benadryl. Then they sent me home.

“I went to an urgent care facility and the doctor there gave me prednisone to help with the rash. It’s a week later and the rash has cleared some but I still have it. I felt all alone during this time. When you watch you body being attacked by a foreign substance it makes you really evaluate your reasons for subjecting yourself to such a risk.

“I will never ever take a drug like this again. Since this has happened I am trying to share my story because this can happen to anyone. I have read a lot of bad stories with this since my little ordeal and don’t think you’re immune to these same issues.”

Humira Drug Interactions:

First, we cannot list all the potential drug interactions with Humira. The list is just too long. Please make sure your health care providers know ALL the medicines you are taking so they can double check to make sure you are not getting into trouble.

Live vaccines are a potential problem. Before getting vaccine against shingles or other live vaccines, ask if there could be a serious problem!

Other biologicals (monoclonal antibodies with “mab” in the generic name. Such drugs may increase the risk of serious infections.

Antidepressant bupropion (Wellbutrin) may not work as well with Humira on board.

Carbamazepine (Tegretol) may not work as well to control seizures.

Statins (some cholesterol-lowering drugs like atorvastatin, fluvastatin or simvastatin may not work as well as expected)

This is just a partial list of drug interactions. Please double-check with your provider to make sure you are not getting into trouble with other medicines you take. Ask the physician, nurse practitioner or PA to use the drug-interaction checker on the computer and notify you if there are any worrisome combinations.

Want to read more about TNF blockers? Here is a link to an article we wrote about this class of medications.

Share your own Humira story below in the comment section.

New effective, safe and cheap treatment strategy for rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic auto-immune disease that causes pain and stiffness in the joints, fatigue, bone damage and, eventually, loss of mobility. RA afflicts around 1% of people in the western world; in Belgium, 80,000 to 100,000 people currently live with the disease.

Because there is no known cure for RA, physicians focus treatment on suppressing disease activity. Therapies have improved in recent years, and clinical studies show that intensive treatment of early RA can prevent joint damage and improve patients’ quality of life.

In the two-year study, called ‘CareRA’ (Care in early RA), researchers and clinicians in the rheumatology unit at University Hospitals Leuven examined various therapies for early RA. Their goal: to find the optimal combination and dosage of three commonly prescribed antirheumatic drugs (methotrexate, sulfasalazine and leflunomide) in combination with glucocorticoids (a class of steroid hormones).

The researchers divided 290 early RA patients into three treatment groups. Each group received a different combination therapy: ‘COBRA Classic’ (methotrexate, sulfasalazine and a high first dose of glucocorticoids), ‘COBRA Slim’ (methotrexate and a moderate dose of glucocorticoids) or ‘COBRA Avant-Garde’ (methotrexate, leflunomide and a moderate dose of glucocorticoids).

All three strategies showed a similarly high efficacy: disease remission was achieved in 7 in 10 patients after 16 weeks of treatment. But the strategies varied significantly when it came to side effects.

The new COBRA Slim strategy, which calls for the least amount of medication, had half as many side effects as the two other strategies — and was just as effective. The strategy would also be easier to implement in daily practice because it is less complicated.

A broader use of this strategy would lead to higher remission rates in the global early RA population and would probably reduce the need for expensive second-line antirheumatic treatment, say the researchers.

“One surprising finding in the study was the high remission values recorded for all of the applied intensive treatment strategies, which were unprecedented internationally,” says Diederik De Cock, doctoral researcher at the Research Centre for Skeletal Biology and Engineering (KU Leuven).

“Methotrexate is very affordable, as are steroids,” says Diederik De Cock. “Implementing this therapy across Flanders would mean substantial savings. At the moment, RA treatment is not yet adequately standardized in Belgium, and this leads to treatment inefficiencies. As a result, more patients require expensive second-line antirheumatic therapies known as biologicals, which can cost up to 15,000 euros per year. By comparison, the COBRA Slim strategy costs less than 1,000 euros. In other words, we can treat up to 15 patients for the same price as a year of treatment with a biological,” says Diederik De Cock.

RA Medications: What is the Best Medication for Rheumatoid Arthritis?

Jennifer Freeman, MD

Doctor of Medicine (M.D.) in 2008 from UT Health San Antonio, Surgeon at TRACC Dallas

Oct 7, 2018 4 min read

Advancements in medical technology now make it possible for many rheumatoid arthritis (RA) patients to receive medical treatments which allow them to continue living a high quality of life. A variety of RA medications specifically help patients reduce inflammatory symptoms and alleviate chronic pain.

Treating RA

RA has no cure; however, there are some highly effective treatment methods available. These treatment methods help to achieve several key goals for RA patients by attacking the inflammation in different ways.

The main goals of RA treatments include:

  • Stop inflammation
  • Manage symptoms
  • Reduce pain
  • Achieve long periods of remission
  • Improve quality of life through better well-being
  • Prevent progressive damage to joints, bones, and cartilage
  • Avoid future health complications to heart, lungs, and other organs

RA Medications

RA medications have greatly evolved over time as a result of the ongoing need for treating these patients and their varying symptoms.

There are many different types of RA medications including (but not limited to):

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Disease-modifying anti-rheumatic drugs (DMARDs)
  • Biologics
  • JAK Inhibitors
  • Steroidal medications

Some of these drug types can be used in conjunction with each other, while others are only pursued when certain RA medications fail to work.

NSAIDs are used to ease the swelling symptoms RA patients feel. If swelling is reduced, it ultimately alleviates pain as well. This is crucial for allowing patients to maintain their quality of life.

The two most common types of NSAIDs are ibuprofen and naproxen, which are well-known and commonly available by the brand names of Advil and Aleve, respectively. There are some additional NSAIDs that are available over-the-counter or through a doctor’s prescription.

Some patients may respond differently to these types of medications and can potentially experience side effects in their liver and stomach. Many patients respond well to taking NSAIDs, though they are a short term solution and aren’t meant to control disease course.

DMARDs modify the course of RA by interrupting the immune attacks that cause the inflammation in the joint tissue. Most frequently, DMARDs work effectively on patients if taken during the first few months of diagnosis. Some patients may find that DMARDs take up to six months to start working.

One of the most commonly known DMARDs is methotrexate. There are others commonly used like leflunomide, hydroxychloroquine, and sulfasalazine, which are often prescribed to RA patients.

Patients taking DMARDs may be more susceptible to infections as these drugs can weaken their immune systems. RA patients taking DMARDs must be alert to signs of infection and maintain healthy habits as preventive measures.

Biologics, or biological response modifiers, are a type of DMARD. Biologics alleviate RA symptoms by targeting the part of the immune system that attacks joint tissue and causes inflammation.

Biologics are also found to work effectively on moderate to severe cases of RA. Even when other treatments have not shown to work, often times biologics prove to be effective for many patients.

Biologics can be taken in conjunction with other DMARDs like methotrexate. Biologics may be more fast-acting than traditional DMARDs as well. However, like DMARDs, biologics can also weaken patients’ immune systems and leave them susceptible to infections.

This form of medication is only taken by injection, unlike the others which are typically oral medications. Some of the most common brand names of RA biologics include Humira, Amjevita, Rituxan, Orencia, and many more.

Biologics are a newer form of RA medication and so the long-term side effects, if any, are unknown at the present. However, patients have reported that biologics can cause pain and rashes at the injection site, which may be due to an allergic reaction.

JAK Inhibitors

The newest form of DMARD is the immune inhibitor known as JAK inhibitors. These medications block the Janus kinase (JAK) pathways, which cause immune responses that trigger the joint inflammation. JAK inhibitors are effective at alleviating symptoms in moderate to severe cases of RA. JAK inhibitors are also taken in cases where the patient can’t tolerate traditional DMARDs.

The brand name for the new JAK inhibitors is Tofacitinib, which is an oral medication taken twice daily. JAK inhibitors, like traditional DMARDs and biologics, can leave the patient more susceptible to infection.

Because it is a newer drug recently approved by the FDA in 2012, JAK inhibitor medications require ongoing studies. Experts will continue to evaluate its safety, side effects, and overall long-term effectiveness in controlling RA symptoms.

Steroidal Medications

In some cases, doctors may recommend steroidal medications as they are fast-acting anti-inflammatory treatments. These medications are used to control inflammation while patients wait for NSAIDs and DMARDs to take effect.

They are, however, extremely potent and only used as short-term treatments for managing symptoms and controlling pain due to their side effect profile. Doctors use a corticosteroid like prednisone typically in low doses.

RA Medication Outcomes

There are three primary strategies that doctors follow when treating RA patients with medications. These treatment strategies include:

  • Aggressively treating symptoms as early as possible
  • Targeting remission to eliminate signs of inflammation for as long as possible
  • Tightly controlling disease activity to keep it to a minimum and to prevent further joint damage

RA medications, combined with other treatment methods, can allow many patients to restore their quality of living and go on to live without chronic pain.

The ideal outcome with RA medications is that the patient achieves remission and no longer experiences symptoms caused by inflammation. If patients can reduce the frequency of flare-ups and increase their periods of remission, then the treatment is considered effective in managing the disease progression.

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