Drug Treatment for Rheumatoid Arthritis: What Are Your Options?
What is Rheumatoid Arthritis (RA)?
Normally, inflammation is a normal process used for repair of injury or illness. However, in an autoimmune disease like RA, healthy tissues are attacked. RA cannot be cured but there are treatments that help control the pain, inflammation and joint destruction.
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.
What Are Common Side Effects with Methotrexate?
MTX and leflunomide should not be used in pregnancy or breastfeeding. Any woman with rheumatoid arthritis 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?
Enbrel, Remicade, Humira, Simponi, and Cimzia are tumor necrosis factor (TNF) blockers. The use of TNF blockers, with or without methotrexate, is recommended for patients with early rheumatoid arthritis who have more severe disease or who fail non-biologic DMARDs.
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?
Nonsteroidal anti-inflammatory drugs (NSAIDs) are also used to alleviate pain and decrease inflammation but do not reduce joint damage. Common NSAID examples include ibuprofen (Advil, Motrin), naproxen (Aleve), diclofenac, and celecoxib (Celebrex).
Glucocorticoids (steroids) such as prednisone, prednisolone or triamcinolone can provide rapid relief and are given in pill form or by injection. However, these are usually given early in therapy to lower inflammation and pain while slower acting drugs take effect. Glucocorticoids are also reserved for more severe RA or flare-ups due to toxicity with long-term use.
Xeljanz: An Oral Biologic RA Treatment
Xeljanz is the first oral biologic in a new class of drugs called Janus Kinase (JAK) inhibitors. Xeljanz is given twice daily in pill form if you have had an inadequate response to methotrexate; the XR form is given once daily. It can be used alone or with nonbiologic DMARDs such as methotrexate.
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 Anti-rheumatic Drugs and Biologic Agents in the Treatment of Rheumatoid Arthritis. Arthritis Care & Research 2012;64:625–39. DOI 10.1002/acr.21641 Accessed 6/26/2016. 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: 4/27/2015. Accessed 6/26/2016. 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 6/26/2016. 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 5/21/2015. http://www.uptodate.com/contents/rheumatoid-arthritis-treatment-beyond-the-basics?source=search_result&search=rheumatoid+arthritis&selectedTitle=3%7E27
- Pfizer. Xeljanz and Xeljanz XR Prescribing Information. Revised Feb 2016. Accessed 6/26/2016. http://labeling.pfizer.com/ShowLabeling.aspx?id=959