Most people diagnosed with RA are taking some type of medication for it. Rheumatoid arthritis is a serious illness that requires treatment. Though there is no cure, getting on the right medication can mean drastic improvements in quality of life. Medications are important in decreasing flares, controlling pain, preventing deformities, and even prolonging life.
There are so many different kinds of rheumatoid arthritis drugs, but what's the best for me?
There are many different types of drugs available to treat RA. From steroids to non-steroidal anti-inflammatories, to disease-modifying drugs and biologics--each has pluses and minuses and your doctor and you are the only ones who can truly decide what works best.
Deciding on a good treatment takes more than just a formulaic approach
Doctors take into account multiple factors before deciding on a medication including age, gender, disease activity, and medical comorbidities. The goal is to find, sometimes its a partially trial and error, the best strategy for your unique case. Here are the most common treatment options:
Non-steroidal anti-inflammatory drugs (NSAIDs)
These are the typical painkillers that you see sold over-the-counter at drugstores, pharmacies, and grocery stores everywhere. Your ibuprofen, Advil, and Motrin - NSAIDs are pain reducers that help reduce inflammation. They are also available in stronger doses by prescription. They work by targeting a molecule called prostaglandin, limiting its production in the body. Prostaglandins are molecules that tell your body to increase pain and inflammation - something we want to reduce in rheumatoid arthritis. The most common side effects of NSAIDs are nausea and vomiting, constipation, diarrhea, headache, rash, and drowsiness. For those who have stomach problems, NSAIDs are also known to be associated with a risk of gastric ulcer. This is because they are affecting compounds that help protect the lining of your stomach from the acidity of its secretions. However, the benefits of NSAIDs are generally much greater than the level of risk they pose, especially at lower doses. Many rheumatoid patients are advised to take NSAIDs to help control their pain and inflammation.
Also known as corticosteroids, these fast-acting drugs are helpful in reducing acute inflammation quickly. Usually, they are used in initial treatment, so that we can reduce the disease activity to a level that is more manageable for other, long-term medications available. An advantage of steroid treatment is that it can be localized to the affected joint via injection. This way, we can spare the rest of our body from side effects of a systemic dose. However, steroids still need to be used carefully, because they come with many side effects. For one thing, steroids tend to lose efficacy over time, and so we should never take them longer than we really need. Secondly, steroids can cause serious problems with weight gain, blood pressure, diabetes, and even heart disease. Steroids are best used to treat an acute flare, helping bridge a patient from severe and active disease into remission, when another, safer drug can then take over.
Disease-modifying anti-rheumatic drugs (DMARDs)
DMARDs are drugs that are most often used in the long-term treatment of rheumatoid arthritis. They work by suppressing the immune system to slow down the progression. Some common generic DMARDs include methotrexate, hydroxychloroquine, sulfasalazine, azathioprine, and leflunomide. Methotrexate is by far the most prescribed, especially as the first drug in people newly diagnosed with rheumatoid arthritis. It's a weekly treatment, and interestingly it's also used to treat some cancers, though at a much higher dose.
Biologics are a special category of DMARDs and are helpful in that they can actually change the outlook of your disease in the long run. They can either be used alone or used in combination with another DMARD. They work by disrupting cellular events that lead to inflammation in rheumatoid arthritis, and they actually have a potential to stop the disease process in its tracks. However, they do increase someone's risk of infection, and they become less effective over time. Many have worsening side-effects with prolonged use as well. This requires careful monitoring and a potential need to switch drugs in the future. One big downside of biologics is that they are usually incredibly expensive.
There are several different types of biologics out there for rheumatoid arthritis: Tumor necrosis factor (TNF) inhibitors, T-cell inhibitors, B-cell inhibitors, and Interleukin inhibitors. Most biologics are either injected or infused through an IV. Some common names for biologic treatments include Enbrel, Humira, and Remicade.
Another potential danger of taking biologics is the increased risk of infection. Notably, tuberculosis can be exceptionally dangerous in anyone who is on a biologic. If someone is carrying a latent form of tuberculosis, they are at an incredible risk of this bug reactivating once they start a biologic. For this reason, a tuberculosis test is absolutely necessary before starting any biologic for rheumatoid arthritis.
Janus Kinase (JAK) inhibitors
These high-tech drugs are specific targets for an enzyme called JAK, which is an important messenger in the immune system. The JAK enzyme is crucial in the inflammatory process, so inhibiting can help curb inflammation and reduce disease activity in rheumatoid arthritis. The first, FDA-approved JAK inhibitor is Tofacitinib, and it's more commonly referred to as Xeljanz or Xeljanz XR. It has a similar risk profile to biologics, and those who take JAK inhibitors are also required to be tested for tuberculosis.
No matter what drug you're on, working closely with a trusted healthcare provider is the best and safest way to treat your rheumatoid arthritis
There are many different drugs available that can help treat your rheumatoid arthritis. Depending on your individual factors, history and disease progression, one might be better for you than others. No matter what you end up using, always work closely with your healthcare team to make sure risks and side effects are appropriately monitored. Be especially cautious when taking a biologic or a JAK inhibitor since there are significant risks such as infection that require special monitoring.