Best Medicines for Rheumatoid Arthritis



Rheumatoid Arthritis Medication

Medication is the primary form of treatment for rheumatoid arthritis (RA), an inflammatory condition of the joints for which there is no cure.

DMARDs, corticosteroids, and NSAIDs are often prescribed for symptoms of RA.
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Some drugs focus on merely treating symptoms, temporarily reducing the pain and inflammation of RA. But others, called disease-modifying anti-rheumatic drugs, or DMARDs, are able to change or slow the progression of the disease, helping to prevent severe joint damage and other complications from developing. (1)

Medication for rheumatoid arthritis typically falls into one of three categories:

The Importance of Early Drug Treatment for Rheumatoid Arthritis

Rheumatoid arthritis may begin in a gradual and subtle way, but the disease ultimately causes joint damage in 85 percent of people with the disease, according to the Johns Hopkins Arthritis Center. (3)

Given that the majority of this irreversible damage occurs within the first two years of the disease, early diagnosis and treatment is vital to protecting the joints and preventing disability. (1,2,3)

Treatment with disease-modifying drugs can help stop disease activity, as well as joint and bone destruction. Along with medication, various lifestyle changes can help reduce RA-related joint and bone damage, including:

  • Quitting smoking cigarettes
  • Engaging in low-impact exercises
  • Losing weight
  • Adopting a healthier diet, particularly an anti-inflammatory diet (1)

DMARDs for Treating Rheumatoid Arthritis

There is no cure for RA, but DMARDs are the gold standard of RA treatment.

Each conventional (nonbiologic) DMARD is different, but they all work by slowing the inflammatory process of the body, protecting the joints from further damage. These drugs are generally prescribed shortly after diagnosis. (4)

Which DMARD your doctor prescribes depends on numerous things, including the severity of the disease and the balance between possible side effects and the benefits of the DMARD. But because DMARDs lose their effectiveness over time, it's rare for anyone to remain on the same medication for more than two years at a time, according to the consumer health information company A.D.A.M.

Methotrexate Is a Popular DMARD Used to Treat RA

The most frequently used DMARD for RA is Trexall (methotrexate), which takes up to six weeks to start working, with the full effect not seen until after 12 weeks of treatment. Up to 90 percent of people with RA take methotrexate at some point during treatment, according to the Arthritis Foundation. (4)

About 20 percent of patients eventually stop taking methotrexate due to its side effects, which include upset stomach, sore mouth, muscle aches, and hair thinning due to a drop in folic acid levels from the drug. Patients are often given folic acid supplements to reduce these side effects.

Your doctor may prescribe other DMARDs along with methotrexate, including:

These drugs may cause various other side effects, such as rash, abdominal pain, and vision and eye problems. (5,6)

Biologic DMARDs for Treating Rheumatoid Arthritis

Biologic DMARDs work more quickly than conventional DMARDs — some in as little as two weeks — but must be injected by your doctor. These drugs interfere with the immune system's ability to launch the damaging inflammatory process by targeting specific steps in this process.

What Is Anti-TNF Therapy?

The first types of biologics that hit the market work by binding and inhibiting tumor necrosis factor alpha (TNF), a pro-inflammatory immune system substance. These drugs may be used in combination with methotrexate, though two biologics are never used in combination with each other. (7)

TNF inhibitors include:

The Food and Drug Administration warns that TNF inhibitors may be associated with an increased risk of lymphomas (cancer of the lymph nodes). But research published in August 2019 in the journal Annals of Rheumatic Diseases suggests these drugs don't affect lymphoma risk, which may actually be due to RA-related inflammation. (8)

Other biologics target other immune system factors, such as interleukin-1 (IL-1), IL-6, CD20-positive B cells, and T cell activity. These drugs are usually only prescribed if you're unresponsive to treatments with methotrexate and a TNF inhibitor. (1,2,3,5)

These other biologics include:

A drug called tofacitinib (Xeljanz, Jakvinus) is also available. It belongs to a new subclass of DMARDs called JAK inhibitors, which work by blocking another part of the body's immune system response: Janus kinase (JAK) pathways. This type of DMARD, like conventional DMARDs, can be taken orally. (9)

Corticosteroids for Treating Rheumatoid Arthritis

Corticosteroids, such as prednisone and prednisolone, are strong anti-inflammatory drugs that can be taken by mouth or injected, either into the bloodstream or directly into the joint.

These drugs are often used while waiting for DMARDs to take effect, and are sometimes also prescribed to enhance the effects of a DMARD. They can quickly reduce pain, stiffness, swelling, and tenderness of joints.

But corticosteroids are only used for short-term relief because they can cause a number of serious side effects in the long run, including:

NSAIDs for Treating Rheumatoid Arthritis

Able to help with pain and minor inflammation, NSAIDs are used for temporary RA relief but cannot reduce the long-term damaging effects of RA or change the course of the disease. (10)

Over time, NSAIDs can increase your risk of gastrointestinal bleeding, fluid retention, and heart disease.

Over-the-counter NSAIDs include:

Prescription NSAIDs include:

Controlling RA Symptom Flare-Ups With Medication

Even with regular treatment, you may occasionally experience flare-ups — periods of increased disease activity that causes spikes in symptoms.

Mild flare-ups can sometimes be treated at home with NSAIDs, rest, hot or cold compresses, or gentle exercise. If these treatments don't work, your doctor may prescribe oral corticosteroids, which will help reduce the inflammation causing your symptoms, and possibly alter any conventional or biologic DMARDs you may be taking.

Importantly, it's best to try to treat your flare-up rather than take the wait-and-see approach to prevent further joint damage. (11)

Rheumatoid Arthritis Medication and Pregnancy

Research presented in September 2019 at the annual meeting of the American College of Rheumatology shows that as many as half of women with RA stop taking their medication during pregnancy. But doing so can cause disease activity to increase, potentially impacting unborn babies. (12)

Many RA medicines are considered safe to take during pregnancy, including TNF inhibitors, oral steroids, and NSAIDs. Please discuss with your doctor, because not all drugs are created equal.

Women with RA who become pregnant should discuss their medication options with their rheumatologist before making changes to their medication usage.






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Date: 09.12.2018, 21:33 / Views: 64162