Rheumatoid arthritis (RA) is an autoimmune disease. This means that the immune system is attacking part of its own body. For those with RA, the immune system is attacking the lining of the joints, usually in the hands and feet. Symptoms include stiff, swollen, and painful joints.
RA is a progressive disorder, so it can worsen and spread to other areas of the body, including other joints and major organs. There’s currently no cure for RA, but there are several effective treatment options.
The three primary treatment options for severe and advancing RA include NSAIDS, corticosteroids, or disease-modifying antirheumatic drugs. These drugs can help alter how the immune system works, which results in slower skin cell growth and reduced inflammation.
Disease-modifying antirheumatic drugs include nonbiologics or biologics.
Nonbiologics include methotrexate, cyclosporine, hydroxychloroquine, sulfasalazine, and leflunomide.
Biologics that are currently available include:
- infliximab (Remicade)
- adalimumab (Humira)
- etanercept (Enbrel)
- golimumab (Simponi)
- certolizumab pegol (Cimzia)
- anakinra (Kineret)
- tocilizumab (Actemra)
- abatacept (Orencia)
- rituximab (Rituxan)
- tofacitinib (Xeljanz)
Disease-modifying anti-rheumatic drugs, known as DMARDs, are usually the first-line treatment in combination with an NSAID or steroid for RA. These drugs are effective in slowing the progression of the disease, so they’re often prescribed as soon as a diagnosis is made. Sometimes they’re even started before the diagnosis is confirmed. Although DMARDs are very effective, it can take several weeks or even months before they begin taking effect. Hence, doctors also start them in combination with an NSAID or steroid for symptom resolution.
DMARDs work by suppressing the immune response, which helps to reduce inflammation. Because of the way they alter the course of the disease, they help to prevent permanent joint damage and other complications of RA.
Several different drugs make up this class, and each has its own level of effectiveness and side effects. The most commonly used drug is methotrexate (Trexall), but figuring out which one is the most effective for you may end up being a case of trial and error.
Nonsteroidal anti-inflammatory drugs, commonly called NSAIDs, may be recommended along with prescription treatment. These include medications you probably have at home like ibuprofen (Motrin and Advil) and naproxen (Aleve). These drugs work well for relieving acute pain and inflammation. They don’t affect the progression of RA, or prevent long-term joint damage or other complications.
Biological therapies, or biologics, are a new type of DMARD, but they’re different enough to be put in a class by themselves. Unlike traditional DMARDs, which affect the whole immune system, biologics target specific proteins that affect the immune response. One type is genetically engineered to block a protein called cytokine, a kind of messenger that tells the immune system to react. Another type targets a protein called tumor necrosis factor (TNF), which increases inflammation.
Biologics might seem less convenient than other DMARDs, because they have to be injected in a medical setting over a period of several hours. But this might become more convenient since doses are usually given only once a month.
Generally, biologics are only recommended for those who haven’t responded well to non-biologic DMARDs, or for those who can’t take non-biologic DMARDs. In many cases, both biologics and traditional DMARDs are given in combination, often along with NSAIDs.
Traditional DMARDs and biologics can have a laundry list of side effects, yet most people tolerate the drugs well. But because of the way they suppress the immune system, both types of drugs carry an increased risk of infection. Talk to your doctor about vaccinations to prevent shingles, pneumonia, and other illnesses.
Each DMARD has different side effects, so you’ll want to discuss the side effect profiles of each drug you’re prescribed with your doctor. Some common reactions include:
- upset stomach
Biologics will generally have the same side effects, along with a few extras like:
- skin reactions at the injection site
- sore throat
- high blood pressure during the infusion
- pain where shot was given
Certain medications can also carry more serious side effects. Your doctor may want to monitor your liver and kidney function, blood pressure, and your heart and lungs. It’s very important that you do not stop taking your medication without talking to your doctor. Make an appointment to discuss any concerns about your treatment. The benefits of DMARDs and biologics typically outweigh any risks, and most side effects can be treated or subside on their own.