Rheumatoid arthritis treatment can include medications that slow the progression of joint damage from rheumatoid arthritis. These drugs are called disease-modifying antirheumatic drugs (DMARDs), and they are an important part of an overall treatment plan. What are these drugs, and how do they work?

Disease-modifying drugs act on the immune system to slow the progression of rheumatoid arthritis. This is why they are called "disease-modifying." Many different medicines can be used as DMARDs in the treatment of rheumatoid arthritis, but some are used more often than others:

Rheumatrex (methotrexate) is the most commonly used DMARD. This is because it has been shown to work as well or better than any other single medicine. It is also relatively inexpensive and generally safe. Like most DMARDs, methotrexate has side effects; it can cause stomach upset, can be toxic to the liver or bone marrow, and can cause birth defects. In rare cases, it can also cause shortness of breath. Regular blood work is necessary when taking methotrexate. Taking folic acid helps reduce some of the side effects. Methotrexate's biggest advantage might be that it has been shown to be safe to take for long periods of time and can even be used in children.
Biologic drugs: Enbrel (etanercept), Humira (adalimumab), Kineret (anakinra), Orencia (abatacept), Remicade (infliximab), and Rituxan (rituximab). These are the newest drugs for rheumatoid arthritis, and are either injected under the skin or given directly into a vein. They work by neutralizing the immune system's signals that lead to joint damage. When used with methotrexate, these medicines help most people with rheumatoid arthritis. These drugs are thought to have fewer side effects than other DMARDs. One side effect is the risk for potentially severe infections. These medicines can also adversely affect your liver or blood counts and should be used with caution in patients with weak hearts (congestive heart failure). Other potential long-term effects won't be known until the drugs have been used by patients for many years.
Plaquenil (hydroxychloroquine) and Azulfidine (sulfasalazine) are used for mild rheumatoid arthritis. They are not as powerful as other DMARDs, but they usually cause fewer side effects. In rare cases, Plaquenil can adversely affect the eyes, and patients taking this medicine should be seen by an ophthalmologist at least once a year.
Minocin (minocycline) is an antibiotic. But it may help RA by stopping inflammation. It can take several months to start working and up to a year before the full effects are known. When taken for long periods, minocycline can cause discoloration of the skin.
Arava (leflunomide) works about as well as methotrexate and can work even better in combination with it. The side effects are similar to methotrexate. Sometimes Arava causes diarrhea and can't be used. Since Arava is known to cause harm to a fetus, women must take special precautions to not get pregnant while on it.
Neoral (cyclosporine) is a powerful drug that often works well in slowing down joint damage. But because it can hurt the kidneys and has other potential side effects, it is usually used for severe rheumatoid arthritis after other drugs fail.
Imuran (azathioprine) is used for many different inflammatory conditions, including rheumatoid arthritis. The most common side effects are nausea and vomiting, sometimes with stomach pain and diarrhea. Long-term use of azathioprine is associated with an increased risk of cancer.

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Do You Have Fibromyalgia Pain?

Cymbalta is approved for the management of fibromyalgia.

Important Safety Information

Cymbalta^® (duloxetine HCl) is approved for the treatment of depression and generalized anxiety disorder, and for the management of diabetic peripheral neuropathic pain and fibromyalgia.

What should I talk about with my healthcare provider?

Patients on antidepressants and their families or caregivers should watch for new or worsening depression symptoms, unusual changes in behavior, thoughts of suicide, anxiety, agitation, panic attacks, difficulty sleeping, irritability, hostility, aggressiveness, impulsivity, restlessness, or extreme hyperactivity. Call your healthcare provider right away if you have thoughts of suicide or if any of these symptoms are severe or occur suddenly. Be especially observant within the first few months of antidepressant treatment or whenever there is a change in dose.

You should also know that:

Suicide is a known risk of depression and some other psychiatric disorders.
Antidepressants may increase suicidal thoughts or behaviors in some children, adolescents, and young adults especially within the first few months of treatment or when changing the dose. No increased risk has been shown for adults over age 24, and risk decreased for those over age 65.
All patients starting therapy should be monitored appropriately and observed closely for new or worsening depression symptoms, suicidal thoughts or behavior, or unusual changes in behavior.
Cymbalta^® is not approved for use in patients under age 18.

Who should NOT take Cymbalta?
You should not take Cymbalta if:

You have recently taken a type of antidepressant called a monoamine oxidase inhibitor (MAOI)
You have uncontrolled narrow-angle glaucoma (an eye disease)
You are taking Mellaril^® (thioridazine)

What other important information should I discuss with my healthcare provider?
Before starting Cymbalta, tell your healthcare provider:

about all of your medical conditions, including kidney problems, glaucoma, or diabetes
about your alcohol use
if you are taking nonprescription or prescription medicines, including those for migraine, to address a possible life threatening condition
if you are taking NSAID pain relievers, aspirin, or blood thinners. Use with Cymbalta may increase bleeding risk
if you are pregnant, plan to become pregnant during therapy, or are breastfeeding an infant

While taking Cymbalta, tell your healthcare provider:

if you have itching, right upper belly pain, dark urine, yellow skin/eyes, or unexplained flu-like symptoms, which may be signs of liver problems. Severe liver problems, sometimes fatal, have been reported
if you have high fever, confusion, and stiff muscles to address a possible life-threatening condition
before stopping Cymbalta or changing your dose
if you experience dizziness or fainting upon standing, especially when first starting Cymbalta or when increasing the dose. Your healthcare provider may periodically check your blood pressure while you are taking Cymbalta

If you have any questions, talk to your healthcare provider before taking Cymbalta.

What are the possible side effects of Cymbalta?

The most common side effect of Cymbalta was nausea. For most people who had it, the nausea was mild to moderate. Other common side effects included dry mouth, sleepiness, constipation, decreased appetite, and, increased sweating. This is not a complete list of side effects.

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