Understanding Rheumatoid Arthritis Medications
With contributions from Krystina and Effie.
If you’ve recently been diagnosed with rheumatoid arthritis (RA) or are struggling with your treatment plan, the medication options can be confusing. There are various drug classes and they work in different ways to treat your rheumatoid arthritis symptoms or slow the progression of the condition.
What Are the Goals of Rheumatoid Arthritis Treatment?
Conventional treatment for rheumatoid arthritis often has several goals.
- Reducing joint pain, inflammation, and stiffness.
- Preventing joint damage or deformities, and organ damage.
- Reduce any potential long-term complications.
- Relieve the symptoms of rheumatoid arthritis.
- Improve overall quality of life and daily living.
- Stop or slow the progression of rheumatoid arthritis.
Depending on your symptoms and the progression of your rheumatoid arthritis, your doctor and rheumatologist may focus on three different types of treatment strategies: early and aggressive treatment, remission targetting, or firm disease control.
Early and aggressive treatment focuses on ending or reducing the levels of inflammation caused by your rheumatoid arthritis as soon as possible.
Remission targetting concentrates on stopping inflammation or any related-rheumatoid arthritis disease activity and getting it to a remission state. This state means minimalizing signs or symptoms of active inflammation.
The last treatment strategy is firm disease control and it focuses on keeping rheumatoid arthritis progression and its symptoms at a minimal or nonexistent in order to prevent any long-term complications, such as joint and organ damages.
Rheumatoid Arthritis Medications 101
There are five drug classes that are typically used to treat rheumatoid arthritis. Although they can each be used separately, they are often most helpful when used in conjunction with one another to produce the best results. Keep on reading to learn about these common rheumatoid arthritis medications.
Disease-Modifying Anti-Rheumatic Drugs (DMARDs)
A drug from the DMARD category is often selected shortly after diagnosis. DMARDs are known to slow or even halt the progression of rheumatoid arthritis.
DMARDs work by stopping the immune response that causes inflammation. However, they can take several months to be effective.
Though they are often effective on their own, at least initially. Sometimes it’s used in correlation with a glucocorticoid, or an NSAID to control pain.
Like all medications, DMARDs are not without their side effects. Because their action is to block immune response, they may actually reduce immunity, which can lead to increased risk of infections and subsequent illnesses.
For some people, DMARDs may also be hurtful to organs such as the kidneys and liver, so routine blood testing is crucial.
Conventional DMARDs include methotrexate, hydroxychloroquine, sulfasalazine and leflunomide.
There are various side effects that may be associated with these drugs, including stomach upset, sore mouth, increased risk of infections, liver damage and bleeding (methotrexate), damage to the retina of the eye (hydroxychloroquine), rash, hair loss, liver damage, weight loss, diarrhea (leflunomide), orange tinge of the urine, tears and sweat, and sensitivity to light and headaches (sulfasalazine).
Rheumatoid arthritis and hair loss (along with several other of the symptoms) is common, so it can be difficult to distinguish whether it is caused by rheumatoid arthritis or by the medication.
Biologic Response Modifiers
Biologic response modifiers, or “biologics,” are a subcategory of DMARDs. They are intravenous medications that are given as an infusion.
An advantage to biologics is that, unlike DMARDs, which can decrease immune function, biologics work by targeting a specific immune response. This means that the risk of lowered immunity and subsequent illness is much lower.
Examples include adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade) and rituximab (Rituxan).
The potential side effects can be serious and include infections with bacteria and fungi, nerve disorders (including multiple sclerosis) and heart failure.
In addition, there is an increased risk of allergic reactions, including the most severe form – anaphylaxis, when taking infliximab.
JAK Inhibitors (or Targeted Synthetic DMARDs)
JAK inhibitors are a new subcategory of DMARDs. This new medication specifically blocks the Janus kinase (JAK) pathway, which is involved in immunity.
An example of a JAK inhibitor is tofacitinib, which has an advantage over biologics, as it can be taken orally.
Side effects that have been associated with it include various bacterial infections, anemia, headaches, high blood pressure, liver damage (including fatty liver) and in rare cases cancer.
Glucocorticoids, also known as corticosteroids, can be used for rheumatoid arthritis treatment but are often used on a short-term basis, when symptoms flare up or when initiating treatments that may take several months to take effect.
Steroids are potent anti-inflammatory drugs that are available in pill or injection form. They also help decrease joint pain and stiffness and are recommended to treat rheumatoid arthritis flare-ups. They have many possible side effects, including RA weight gain, aggravation of diabetes, cataracts, osteoporosis and increased risk of infections.
Glucocorticoids are quick acting and are effective in reducing inflammation. They reduce inflammation by decreasing the activity of the immune system. They also reduce the production of chemicals that cause inflammation, which lowers overall tissue damage.
If possible, glucocorticoids should be used on a short-term basis. This is because the serious side effects are tied to the dosage and duration the drug is administered.