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How to Know If Advanced Rheumatoid Arthritis Therapy Is Right for You

Medically reviewed by Nancy Carteron, MD, FACR on February 1, 2017Written by Elea Carey on February 1, 2017
switching ra treatment

For those with rheumatoid arthritis (RA), nonsteroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs) are often the first-line treatment option.

NSAIDs help pain by reducing inflammation in your joints. And while they’ve been in use for decades and provide a certain level of comfort, they do nothing to prevent joint damage.

Read on to find out more about these RA medications along with advanced therapies that you may want to consider.

Basic RA medications: DMARDs, NSAIDs, and steroids

DMARDs represent a major change in how RA is treated. They suppress your immune system to stop inflammation and actually slow RA’s destruction of joints.

In spite of their benefits, DMARDs come with potential side effects. You shouldn’t get pregnant when you’re taking them because they can cause birth defects or terminate a pregnancy. As well, DMARDs interact with your immune system. You could be more susceptible to infection when you’re taking them.

NSAIDs can cause stomach problems, including ulcers, and increase the chance of bleeding disorders because they thin your blood. Less common side effects include impaired kidney function, heart attacks, and strokes.

Steroids have been known to cause fatigue and body aches. If you take steroids for more than a few weeks, your body can stop making a hormone called cortisol. When you stop taking the steroid, you might experience side effects because of the lack of cortisol, so tapering steroids (gradually reducing your dose) is extremely important.

These side effects might be one reason you’re considering changing or augmenting your treatment, although Schenk points out that patients should weigh the small risk of side effects against the effects of untreated RA. “On balance, we believe that it’s worth accepting a small amount of risk in exchange for the benefit of controlling and relieving the symptoms of this potentially crippling disease. Avoidance of disease-modifying therapy allows RA to gain the upper hand, leading to progressive damage, deformity, and disability.”

For some people, it isn’t the side effects that cause them to consider other treatments. Some find that the standard RA treatment protocol stops working for them. If that’s what’s happened in your case, you might be considering other treatment options.

Biologics

Biologics are sometimes call biologic DMARDs. The idea behind them is similar to the older treatments, but they’re more targeted: Biologics prevent your immune system from creating inflammation. But they’re bioengineered to act like proteins in your body. This type of medication is often used together with the standard treatment regimen. “These new biologics bring about dramatic, quick relief of pain and swelling, comparable to steroids but without the troubling side effects that steroids have,” says Schenk.

The biologics available to treat RA include:

Each biologic has an individual action for stopping RA. Some target particular blood cells. Others, called anti-TNF biologics, act on a protein called the tumor necrosis factor. Most of these drugs are given by injection.

Biologics have improved the lives of many RA patients, but of course they aren’t without their own side effects. They change how your immune system works, so they can make you more prone to certain infections or even cause a shift to another autoimmune process. You also could experience a rash, or hot, tender skin. Schenk agrees that the side effects exist but still advocates for advanced therapy. “In my clinical experience,” he reports, “the risk of major drug toxicity is often far less than 1 percent.”

Stem cells

If traditional RA treatment isn’t working for you because it’s failing or you’re bothered by side effects, you might ask your doctor about stem cell therapy. Stem cell treatments aren’t approved by the FDA and aren’t covered by insurance. However, they are an active area of research.

The takeaway

You face a lot of tough medical choices when you have RA. Deciding on which treatments to pursue is a personal choice and requires that you educate yourself thoroughly on therapies and side effects. If the standard approach to treating RA with NSAIDs, DMARDs, and the occasional steroid isn’t working for you, ask your doctor about additional treatments.

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