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How Chemotherapy Treats Rheumatoid Arthritis


Elizabeth Hanes RN

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You may think of chemotherapy as something doctors give to cancer patients to help shrink their tumors. That is true, but chemotherapy also is used to treat symptoms of rheumatoid arthritis (RA), and even slow the joint damage the disease causes. In fact, doctors consider chemotherapy drugs a first-line treatment for RA.

What is chemotherapy for RA?

Chemotherapy treatment for RA involves a group of medications called disease-modifying antirheumatic drugs (DMARDs). Several medications fall under the DMARDs umbrella, including the classic cancer-fighting drug methotrexate. When you receive chemotherapy for RA, you may take a pill, get an injection, or receive an intravenous (IV) infusion.

RA chemotherapy suppresses an overactive immune system.

Unlike common anti-inflammatory medications such as ibuprofen or prednisone—which treat the pain and swelling of RA—DMARDs treat the cause of RA, which is an overactive immune system. DMARDs modify the activity of your immune system so it slows its attack on your body’s own tissues. 

RA chemotherapy often involves a combination of drugs that do different things. For instance, you may receive a low dose of methotrexate along with a drug that reduces the number of inflammatory cells your body produces. You may also receive a biologic medication  as part of your RA chemotherapy. This is called ‘combination therapy.’

Biologics are a special class of DMARD. Biologics act differently on your immune system than mexotrexate, but the end result is similar: less pain and less joint damage. Your doctor will develop an RA-fighting drug combination that is best for you based on your symptoms and stage of disease.

Who can get chemotherapy for RA?

The American College of Rheumatology recommends all people with an RA diagnosis receive chemotherapy early. Their guidelines recommend even people with mild cases of RA receive chemotherapy because the treatment slows joint damage. When you start chemotherapy soon after diagnosis, you’re more likely to keep your joints functioning longer.

Some people, including people with congestive heart failure, may not be able to receive certain types of medications (such as biologics) often used in combination therapy for RA. 

Chemotherapy takes several weeks to slow the progress of RA.

The most common drug used in RA chemotherapy is methotrexate, and you usually take it as a pill once or twice a week. As part of your combination therapy you also may take other oral medications, get an injection periodically, or receive an infusion, particularly for biologic medications. 

DMARDs do not work fast. You should expect to wait weeks or even months before treatment slows the progress of RA. Your doctor will test your blood periodically to determine how well the chemotherapy is working, and he or she may change your medications from time to time in order to find the most effective treatment.

Chemotherapy is effective for RA but you may experience side effects.

The purpose of chemotherapy for RA is to suppress your immune system, which may make you more vulnerable to infection. Be alert for any signs of infection, such as a fever, and tell your doctor right away if you develop unusual symptoms.

Chemotherapy and biologic medications may cause side effects, although most people do not experience significant problems. Your doctor will tell you what to expect from the specific medications you will be taking. For example, the side effects of methotrexate may include:

  • Nausea and vomiting
  • Sores in the mouth
  • Headache
  • Fatigue
  • Loss of concentration (“brain fog”)
  • Hair loss; this is slow hair loss, unlike chemotherapy for cancer

If you experience unmanageable side effects, let your doctor know as soon as possible so he or she can modify your treatment regimen.
Chemotherapy for RA represents a big step forward in treating the actual disease process instead of treating only the symptoms. Not only can chemotherapy for RA slow the progression of the disease, but it can relieve the joint pain and stiffness the disorder causes.

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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Nov 24, 2015

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Medical References

  1. 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. Agency for Healthcare Research and Quality.
  2. Rheumatoid Arthritis. Medline Plus, National Library of Medicine, National Institutes of Health.
  3. Methotrexate: Managing Side Effects. Arthritis Foundation.
  4. Methotrexate (Rheumatrex, Trexall, Otrexup, Rasuvo). American College of Rheumatology.
  5. Methotrexate. SafeMedication.

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