Drug Treatment for Rheumatoid Arthritis - What Are Your Options?
The treatment of RA has significantly improved in the last 50 years -- treatments have allowed patients to control pain, remain active, and limit progressive joint destruction.
What is Rheumatoid Arthritis (RA)?
RA differs from osteoarthritis, which is due to the wear-and tear on the joints and cartilage over time.
What is the Goal of RA Treatment?
You and your doctor will develop a long-term plan for your RA therapy. Becoming involved in your therapy is important for its success.
What Non-Drug Measures Are Used to Control RA?
You can learn to better control your RA symptoms and maximize your ability to stay active with work, physical fitness and social activities by combining non-drug therapies with your medicines. In severe cases, joint replacement surgery may be elected to treat RA.
What is the First Line of Drug Treatment for RA?
Your doctor may start treatment by prescribing one or more disease-modifying anti-rheumatic drugs (DMARDs). A drug from the nonsteroidal or glucocorticoid anti-inflammatory drug class might be used initially or for more severe RA symptoms to control your acute pain and inflammation.
What are DMARDs?
Methotrexate (MTX) is a first-line DMARD that is often used in conjunction with an anti-inflammatory drug, such as ibuprofen (Motrin, Advil) or naproxen (Aleve). Methotrexate is usually taken once per week as a pill or as an injection.
Other oral non-biologic DMARDs include hydroxychloroquine, leflunomide, and sulfasalazine.
What Are Common Side Effects with Methotrexate?
Regular blood tests may be ordered, and folic acid or leucovorin may be used to lessen the risk of some side effects. MTX and leflunomide should not be used in pregnancy or breastfeeding. Any woman with RA planning a pregnancy should consult with her doctor first.
What If a DMARD Does Not Control the Symptoms of RA?
Biologic DMARD examples include adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade), abatacept (Orencia), certolizumab (Cimzia), golimumab (Simponi), rituximab (Rituxan), and tocilizumab (Actemra).
Most biologics are given by injection and can be added to non-biologic DMARDs, NSAIDs or corticosteriods.
How Do Biologics Work in RA?
Orencia, Rituxan, Kineret, Actemra and Xeljanz are non-TNF biologics and target other immune system molecules; they may be used if a TNF blocker plus methotrexate is not adequate.
What Special Precautions are Needed for TNF Blockers?
You may need vaccinations prior to or during treatment with biologics. Tell your doctor if you have a history of congestive heart failure (CHF), cancer or hepatitis. You will also be tested for tuberculosis (TB) before starting a biologic agent.
What Other Drugs Are Used in Combination with DMARDs and/or Biologics?
Glucocorticoids (steroids) such as prednisone or prednisolone can provide rapid relief and are given in pill form or by injection but are reserved for more severe RA or flare-ups.
Xeljanz: An Oral Biologic RA Treatment
Like other biologics, Xeljanz may be associated with serious side effects such as infections, cancer, and stomach or intestinal tears. Discuss the benefits and risks of this therapy with your doctor.
Finished: Drug Treatment for Rheumatoid Arthritis - What Are Your Options?
- Singh JA, et al. 2012 Update of the 2008 American College of Rheumatology Recommendations for the Use of Disease-Modifying Antirheumatic Drugs and Biologic Agents in the Treatment of Rheumatoid Arthritis. Arthritis Care & Research 2012;64:625–39. DOI 10.1002/acr.21641 Accessed 4/24/2013. https://ww3.iehp.org/~/media/Pharmacy/Clinical/CPGs/RA.pdf
- Up To Date. Wolters Kluwer Health. Patient Information: Rheumatoid Arthritis symptoms and diagnosis (Beyond the Basics). Last update: 3/2012. Accessed 4/24/2013. http://www.uptodate.com/contents/rheumatoid-arthritis-symptoms-and-diagnosis-beyond-the-basics?source=search_result&search=rheumatoid+arthritis&selectedTitle=1%7E27
- Drugs.com Rheumatoid Arthritis. Accessed 4/24/2013. http://www.drugs.com/rheumatoid-arthritis.html
- Up To Date. Wolters Kluwer Health. Patient Information: Rheumatoid Arthritis symptoms and diagnosis (Beyond the Basics). Last update: 3/2012. Accessed 4/24/2013. http://www.uptodate.com/contents/rheumatoid-arthritis-treatment-beyond-the-basics?source=search_result&search=rheumatoid+arthritis&selectedTitle=3%7E27
- Pfizer. Xeljanz Prescribing Information. March 2013. Accessed May 27, 2014. http://labeling.pfizer.com/ShowLabeling.aspx?id=959