Rheumatoid arthritis (RA) is a type of inflammatory arthritis. The inflammation is the result of an autoimmune process. This means your immune system targets your own tissues—in this case the joints—and starts attacking them. RA affects about 1.5 million Americans.
RA most commonly affects the knees, wrists, and joints in the hand on both sides of the body. However, it can involve other joints and even organs, such as the lungs, heart or eyes. Along with joint pain, swelling and stiffness, other symptoms include fever, fatigue, and weight loss.
In most cases, the disease is chronic and progressive. Symptoms may be constant, but more often they cycle through flares and periods of remission. Symptoms can also range from mild to severe. You can influence the course of your disease and your symptoms with proper treatment. This involves lifestyle changes, exercise, and medications.
There are two main ways RA drugs work. Some classes aim to reduce symptoms, such as pain and swelling. Others target the disease process itself. Neither of these approaches can cure RA and RA medication side effects depend on the specific RA drug. However, they can improve your quality of life and delay and decrease symptom flares.
Doctors follow expert practice guidelines when choosing medicines to treat RA. These guidelines often recommend early treatment because it offers the best chance of preventing joint destruction and disability. Classes of RA drugs include:
Biologic Response Modifiers—biologics for short—target the immune system to decrease its activity. Biologics can produce and maintain remission of symptoms. Side effects include injection site reactions and flu-like symptoms.
Corticosteroids are powerful anti-inflammatory drugs. However, long-term use can cause serious side effects. Because of this, doctors typically use them for short periods of time to get symptoms under control.
Disease-modifying Antirheumatic Drugs (DMARDs) alter the progression of RA. They slow joint damage, which can gradually improve symptoms. Doctors usually start these early in the disease along with an NSAID. Side effects vary depending on the specific drug.
Nonsteroidal Anti-inflammatory Drugs (NSAIDs) relieve pain and inflammation. They are available over the counter and by prescription. Stomach upset or irritation is a common side effect of NSAIDs. Taking them with food can help. NSAIDs also have the potential to cause serious side effects.
Your doctor will monitor your RA after you start treatment. This includes understanding how often you experience symptoms and how severe they are. Keeping a symptom diary can help you communicate this to your doctor. Some wellness tool apps for smart phones are available specifically for people with rheumatoid arthritis to track daily activities and symptoms. All of this information helps your doctor gauge how well your treatment is working. It may be necessary to change or add medications to get the best result.
Your doctor has choices to make within each class of RA medicine. Finding the right treatment for you, that is effective with the least RA medication side effects, may involve some trial and error. Here are 10 drugs commonly prescribed for RA:
Adalimumab (Humira) is a biologic medication for injection under the skin. You will get the first dose in your doctor’s office. After that, the typical dose is self-administered once a week or every other week.
Celecoxib (Celebrex) is an NSAID, specifically a type called a COX-2 inhibitor. It is a capsule you take once or twice a day, usually with food.
Etanercept (Enbrel) is a self-administered biologic for once- or twice-weekly injection under the skin. Like Humira, you will get the first dose in your doctor’s office.
Hydroxychloroquine (Plaquenil) is a DMARD. It comes as a tablet you usually take once a day with food. For higher doses, your doctor may recommend splitting the dose to twice daily.
Indomethacin (Indocin) is an NSAID. It is available as a capsule, extended-release (ER) capsule, and a suspension. The ER capsule offers the most convenient dosing at once or twice daily with food.
Leflunomide (Arava) is another DMARD you usually take once daily. Your doctor may have you take it more often during the first several days of treatment.
Methotrexate (Rheumatrex, Trexall) is a DMARD that is very effective for RA. It is available as either a tablet or injection under the skin. Doctors usually prescribe a weekly dose to decrease side effects.
Methylprednisolone (Medrol) is a corticosteroid. The dosing for the oral tablets can range from once a daily to several times a day. Your doctor may also taper down your dose. Ask your doctor or pharmacist about your specific dosing.
Prednisone (Deltasone) is also a corticosteroid. It comes as a tablet and an oral solution. The usual dose ranges from once daily up to four times a day with food.
Sulfasalazine (Azulfidine) is an oral DMARD. It comes as a delayed-release tablet to minimize stomach irritation. You should take the tablet with food and a full glass of water. Doctors usually start a low dose and increase it to the full dose of two tablets twice daily.
Remember, medications are just one part of an overall treatment plan. Your doctor may also recommend specific exercise plans, physical therapy, and other lifestyle changes. Doctors usually reserve surgery for severe joint damage or disability.
Researchers continue to make great strides in understanding RA. They are studying joint destruction at the molecular level to explore ways to prevent it. They are also trying to understand genetics related to RA that can help them better match patients to treatments. If you are interested in learning more, talk with your doctor.
