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Getting a Grip on Rheumatoid Arthritis Pain

Options for managing the pain and damage of severe chronic RA.

Other Treatment Options for Chronic Rheumatoid Arthritis: Biologic DMARDs

People with severe rheumatoid arthritis who have a lot of joint damage or who aren’t responding well to the traditional DMARDs may be started on a biologic DMARD. Rheumatoid arthritis is caused by an overactive immune response, Ruderman tells WebMD. Biologic drugs target immune triggers that cause joint inflammation and damage in rheumatoid arthritis. Biologic drugs that may be used include:

  • Tumor necrosis factor (TNF) inhibitors. These drugs include adalimumab (Humira), certolizumab (Cimzia), etanercept (Enbrel), and infliximab (Remicade). They work by blocking TNF, a type of protein called a cytokine that triggers inflammation.
  • Anakinra (Kineret). This drug targets another cytokine called interleukin-1 or IL-1.
  • Abatacept (Orencia). Abatacept inactivates immune cells called T cells.
  • Rituximab (Rituxan). This drug targets B cells, another type of immune cell.

Biologic drugs are often combined with methotrexate to improve their effectiveness. Today, the biologics are administered intravenously or by injection. But the next phase in drug development, Ruderman says, will be oral medications that can achieve the same results.

All of these drugs can have side effects, which is why rheumatologists monitor their RA patients very carefully. For example, methotrexate can cause liver problems. People who take this drug will need to have regular liver function tests.

Infection is one of the biggest concerns with DMARDs. “In a simplistic sense, RA is a disease of an overactive immune system or an immune system that is over-stimulated in certain areas,” says Ruderman. “All of these drugs work by trying to suppress that level of over-activity. But they also suppress normal areas of the immune system.” RA patients who take DMARDs need to be vigilant about hand washing as well as other preventive strategies to avoid getting sick.

Other Treatment Options for Chronic Rheumatoid Arthritis: Steroids, NSAIDs, and Pain Relievers

DMARDs and biologic response modifiers are important agents used to treat chronic rheumatoid arthritis. But they aren’t the only options. Several other medications can be used to treat severe RA, including the following:

  • Steroid medications, such as prednisone. Steroids can quickly reduce RA pain and swelling and slow damage to the joints. They aren’t recommended for long-term use. That’s because they become less effective over time, and they can have serious side effects, including cataracts, diabetes, and thinning bones.
  • Nonsteroidal anti-inflammatory drugs or NSAIDS. NSAIDS such as ibuprofen (Motrin, Advil) and naproxen sodium (Aleve) help relieve pain and inflammation, and are often used together with DMARDs.
  • Pain relievers such as acetaminophen (Tylenol). These medications are another option for relieving pain. They don’t, however, affect joint inflammation.

RA Therapy Is Trial-and-Error

Often it takes several attempts to find the right drug or combination of drugs that effectively treats chronic RA. “That’s one of the most frustrating things in rheumatology today, that it is very much trial and error,” Ruderman says. “We end up trying something, and if it doesn’t work, we try something else."

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