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DMARDs continued...

You may need more than one DMARD to control your inflammation or prevent joint damage, Fradlis says.

Your rheumatologist will test your blood for signs of inflammation and take images of your joints to look for damage. These signs tell the doctor if you need to take a combination of DMARDs.

One successful type of combination treatment is triple therapy, which includes methotrexate, hydroxychloroquine (Plaquenil), and sulfasalazine (Azulfidine). They work together to lower inflammation and joint damage, Fradlis says.

DMARDs can have side effects, but most people can handle them, Fradlis says. You could get rashes, diarrhea, nausea, mouth sores, hair loss, and sensitivity to sunlight. Methotrexate and leflunomide may cause severe birth defects and hurt your liver. Both men and women should use birth control while taking these drugs. You’ll get regular blood tests to make sure your liver is healthy.

Biologics

If DMARDs alone don’t put you in remission, the next step, Goodman says, is a biologic.

These are drugs that stop inflammation. They help slow your out-of-control immune system, prevent joint and organ damage, and help you feel better.

Because biologics put the brakes on your immune system, they may make it harder to fight infections like pneumonia. But the tradeoff is usually worth it, Goodman says.

Biologics are available as injections, pills, and by IV. Your doctor will ask you a lot of questions to find out which one will work best to treat your RA or help predict your risk of side effects.

“It is important to remember that serious side effects do not happen to every patient, and that most patients tolerate biologic therapy well,” Fradlis says.

Biologics are more expensive than DMARDs. Many drug manufacturers offer discount cards and other help to offset the high costs, she adds.

Corticosteroids

Corticosteroids, sometimes just called steroids, treat inflammation and pain. These powerful drugs usually are given at low doses and for a short period of time. You may take them if you have a sudden RA flare.

Usually, you’ll start taking corticosteroid pills at a high dose and taper down to a small one to help reduce side effects. Your doctor could inject corticosteroids directly into an inflamed joint. That may be the safest method, Goodman says. “Daily corticosteroid therapy increases risk of infection, diabetes, osteoporosis, and weight gain.”

If you get pregnant, your doctor may put you on corticosteroids for a while. They can control inflammation until you’re able to return to other drugs.