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Rheumatoid Arthritis: Treatments

Biologics for RA continued...

Biologics are used to treat moderate to severe RA that cannot be controlled by DMARDs. “These are the people for whom a biologic makes a big difference,” says Hardin. “If people don’t respond within six to eight weeks of starting traditional DMARDs, it’s very appropriate to move on to biologics.”

Biologics can be used alone but often are combined with one or more DMARDs or other RA drugs to control symptoms and disease activity. Doctors don't prescribe two biologics together.

Biologics are taken by injection, by IV, or as a pill. Injections can be done at home. IV infusions are always done at a medical center.

Many biologics work by blocking TNF, a chemical your body makes that causes inflammation. Some biologics target other inflammatory chemicals or immune system cells.

Because they slow down the immune system, biologics lower your ability to fight infection. They can cause flare-ups of some infections that aren't active, such as tuberculosis. Some people also have reactions at the IV or injection site.

More widespread IV reactions, which are usually mild, include chest pain, difficulty breathing, and hives. Each drug has its own set of side effects that you should talk about with your doctor.

Corticosteroids: Knocking Down Inflammation

Corticosteroids are strong inflammation fighters that can quickly improve symptoms and reduce swelling. They are less effective at slowing the disease itself. Your doctor may prescribe them to get inflammation under control, or when you have a flare.

For some people, says Hardin, a very low dose of steroids taken by mouth in combination with DMARDs and/or biologics seems to control their RA.

Steroids can cause weight gain and bone loss, raising the risk of osteoporosis. They also may worsen diabetes and increase the risk of infections. Generally, the lower the dose and the shorter the course of steroids, the fewer the side effects.

NSAIDs: Relieving Pain

Nonsteroidal anti-inflammatory medications, such as celecoxib (Celebrex), ibuprofen, or naproxen reduce inflammation and help relieve pain. NSAIDs do not slow joint damage.

“I use less and less NSAIDs every year in my practice,” Hardin says. “I don’t rely on them for much except minor symptom control. I would certainly never treat RA with an NSAID alone.”

NSAIDs can cause stomach problems, including bleeding. Some also have been linked to a greater risk of heart disease and should be used with caution in people who already have heart, liver, or kidney disease.

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