A Guide to Rheumatoid Arthritis Drugs

A comprehensive guide to rheumatoid arthritis drugs

Rheumatoid arthritis (RA) is an autoimmune disorder that causes fluid to build up in the small joints of the hands, wrists, elbows, ankles, feet and knees. Over time, the inflammation from this excess fluid destroys cartilage and bone, which causes joints to become stiff, painful, red and swollen.

Rheumatoid arthritis affects joints symmetrically: if one joint is affected, the same joint on the opposite side of the body also is affected.

Medications and Side Effects

A new study shows using abatacept (Orencia)  plus methotrexate (MTX) “demonstrated robust efficacy…in early RA, with a good safety profile.” Very early RA (2 years of symptoms or less) went into remission while on abatabept. Excitingly, the remission continued drug free after stopping abatacept and MTX (after a 12-month use). “This is the first study to investigate the possibility of achieving absolute drug-free remission after removing all RA therapies,” Emery and colleagues noted. To put numbers on it, 6 months after all medicine was withdrawn nearly 15% of the patients using abatacept and MTX were still in remission versus 8% of those with MTX alone. There were 351 patients in the trial. Be warned, “Serious adverse events were reported in 6.7% of patients receiving abatacept plus methotrexate, 12.1% of those given abatacept alone, and 7.8% of those receiving methotrexate alone. One patient in the combination arm discontinued because of a serious adverse events or infection, as did four in the abatacept monotherapy group, and none of the methotrexate group.”Two main types of medications are used to treat rheumatoid arthritis: disease-modifying antirheumatic drugs (DMARDs) and anti-inflammatories. Anti-inflammatories often are the first line of defense because they provide relief faster than DMARDs, which can take several weeks or months to go into effect.

Anti-Inflammatory Medications

Anti-inflammatories, including corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs), ease inflammation and pain.

Corticosteroid medications

Corticosteroids such as prednisone are temporarily given to treat acute symptoms. They reduce inflammation and pain, as well as slow joint damage. Side effects may include bone loss, cataracts, elevated blood fats, increased appetite and weight gain, elevated blood sugar levels and diabetes.

Over-the-counter NSAIDs

NSAIDs ease pain and reduce inflammation. These include ibuprofen (Advil and Motrin IB) and naproxen sodium (Aleve). Stronger NSAIDs may be prescribed. These include meloxicam (Mobic), etodolac (Lodine), nabumetone (Relafen) and sulindac (Clinoril). Side effects may include tinnitus (ringing sound in ears), stomach irritation and ulcers, heart problems, edema (feet swelling), liver and kidney damage, and an increased risk of blood clots, heart attack and stroke.

Disease-Modifying Medications

DMARDs are designed to slow or stop the inflammatory process that damages joints and internal organs. The drugs are taken weekly either orally or via self-injection and typically start working within 8 weeks. Methotrexate (such as Rheumatrex and Trexall) is the most commonly prescribed DMARD for people newly diagnosed with the disease. It’s been found to be the most effective with the fewest side effects. Other DMARDs include leflunomide (Arava), hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine).

Biologic response modifiers or biologics

Biologics are DMARDs that are prescribed for people with moderate to severe rheumatoid arthritis who don’t respond to other DMARDs like methotrexate. Biologics, which have been in use since 1998, are genetically engineered proteins derived from human genes. They copy the effects of substances naturally made by the body’s immune system. Biologics are given as weekly self-injections or via monthly 2- to 3-hour intravenous infusions at a doctor’s office or infusion center. It can take up to 3 months for biologics to start working. Biologics include: abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituximab (Rituxan) and tocilizumab (Actemra). While corticosteroids and NSAIDs are reasonably priced, the cost of DMARDs and biologics are steep. Prices vary by brand vs. generic and region of the country. But Humira, for example, can cost about $2,700 a month for anyone without insurance and who doesn’t qualify for a price-reduction program.

Side effects of DMARDs

Side effects can include an increased risk of all types of infections including tuberculosis and upper respiratory problems like pneumonia and bronchitis; injection site reactions; nerve disorders; heart problems; inflammation of the optic nerve; liver damage; bone marrow suppression; and multiple sclerosis. Contact your doctor immediately if you experience any signs of infection including chills, fever, sore throat or painful urination.

As with most autoimmune disorders, there is no one-size-fits-all treatment for rheumatoid arthritis. The course of treatment depends on the type and severity of symptoms. However, treatment typically involves a combination of medications. Faster-acting NSAIDs and steroids are often given along with slower-acting, but longer-lasting DMARDs.

Jeannette Moninger is a Denver-based freelance health writer.  

For More Information

Drug-Free Remission a Reality in RA?

Two New Approaches to Treating Rheumatoid Arthritis (MedScape)

UK Researchers Create New Arthritis Therapies That Minimize Side Effects (Arthritis Research UK)

Folic Acid and Folinic Acid for Reducing Side Effects in Patients Receiving Methotrexate for Rheumatoid Arthritis (Journal of Rheumatology)

Scared by Side Effects: Advice for Reducing the Risk of Medication Side Effects (Arthritis Today)

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