DMARDs and TNF-Alpha Inhibitors and Blockers for Rheumatoid Arthritis
Rheumatoid Arthritis Overview
Rheumatoid arthritis (RA) is a chronic autoimmune disorder with no cure, but plenty of advanced treatment options. RA causes your immune system to attack the healthy tissues in your joints, resulting in pain, swelling, and stiffness.
Unlike osteoarthritis, which is a result of normal wear and tear as you age, RA can affect anyone at any age. No one knows exactly what causes it, but new and effective treatments are being developed all the time.
Although there is no cure for RA, there are many options for treatment. These range from painkillers for day-to-day coping to surgery in the worst-case scenario.
Anti-inflammatory drugs, corticosteroids, and medications that suppress the immune system are all possibilities. If you have RA, your rheumatologist will work with you to plan the best course of action. He or she may tailor your treatment to minimize side effects.
DMARDs: Important in Early Treatment
DMARDs, or disease modifying anti-rheumatic drugs, are medications that rheumatologists often prescribe immediately after a positive diagnosis. They can make a big impact early on in the course of the disease. This is because much of the irreparable damage done to joints by RA happens in the first two years. DMARDs suppress your immune system, which diminishes RA’s attack on your joints and subsequently reduces the overall damage.
DMARDs with Painkillers
The main downside to taking DMARDs is that they are slow to act, and therefore leave you with continuing pain. There are several different drugs in this class, but they all work slowly. It can take several months to feel any relief from taking a DMARD. For this reason, rheumatologists often prescribe fast-acting painkillers to take at the same time. Corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs) are both treatment options for RA pain.
TNF-Alpha Causes the Damage
One type of DMARD acts on a substance called tumor necrosis factor alpha, or TNF-alpha. TNF-alpha is one of a group of signaling molecules called cytokines. The immune system cells that attack joints in RA create TNF-alpha. It is responsible for the inflammation that causes the pain and swelling associated with RA. The pathway that leads to damage and swelling in the joints is complex, but TNF-alpha is a major player in the process.
TNF-Alpha Inhibitors and Blockers
One of the most important types of DMARDs on the market right now are called TNF-alpha inhibitors or blockers. This type of DMARD binds to TNF-alpha. There are five drugs of this type: etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade), golimumab (Simponi), and certolizumab pegol (Cimzia). TNF-alpha inhibitors suppress the immune response in your joints by taking TNF-alpha out of the inflammation pathway.
Waiting for Treatment to Take Effect
Some DMARDs take months to show any signs that they are working, which means this type of treatment requires patience. TNF-alpha inhibitors, however, begin to work sooner than other DMARDs. They may start taking effect within two weeks to a month.
Your rheumatologist will help you decide if your medications are having the desired effect and make a choice as to whether or not you need to switch to a different one. Some of these medications work better for some people than others.
DMARDs and Infections
Besides the wait time, the downside of using DMARDs and TNF-alpha inhibitors is that your entire immune system is impacted. This means you will be at a greater risk for infections.
The most common infections that RA patients experience are skin infections, upper respiratory infections, pneumonia, and urinary tract infections. Practicing good hygiene is important, as is steering clear of people who are sick.
When DMARDs and TNF-Alpha Inhibitors Don’t Work
Most RA patients respond well to DMARDs and TNF-alpha inhibitors, but for some people they may not work at all. If this happens to you, your rheumatologist will likely prescribe a secondary TNF-alpha inhibitor as a next step.
Another possibility is to try a different kind of DMARD altogether. Newer drugs are being developed that target the immune system in different ways. Researchers have not yet figured out why some of these drugs don’t work for certain people, but there are new medications being developed every day.
Drug Guide: Biologics. (2013). Arthritis Foundation. Retrieved September 26, 2013, from http://www.arthritistoday.org/arthritis-treatment/medications/types-of-drugs/biologics/drug-guide-biologics.php
● Drug Guide: DMARDs. (2013). Arthritis Foundation. Retrieved September 26, 2013, from http://www.arthritistoday.org/arthritis-treatment/medications/types-of-drugs/disease-modifying-drugs/drug-guide-dmards.php
● Rheumatoid Arthritis Treatment. (2013). Johns Hopkins Arthritis Center. Retrieved September 26, 2013, from http://www.hopkinsarthritis.org/arthritis-info/rheumatoid-arthritis/ra-treatment/#bcell
● When an Anti-TNF Fails for Rheumatoid Arthritis, What’s Next? (2012, August 24). Arthritis Foundation. Retrieved September 26, 2013, from http://www.arthritistoday.org/news/rituxan-versus-anti-tnfs208.php