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    Treating Rheumatoid Arthritis With Disease-Modifying Drugs (DMARDs)

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    DMARD Side Effects and Use continued...

    Biologic drugs: abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), infliximab (Remicade), golimumab (Simponi, Simponi Aria), rituximab (Rituxan), and tocilizumab (Actemra). These are the newest drugs for RA and are either injected under the skin or given directly into a vein. They work by neutralizing one of the immune system's signals (TNF) that lead to inflammation and 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, although rarely, adversely affect your liver or blood counts. Other potential long-term effects won't be known until the drugs have been used by patients for many years.

    Azathioprine ( Imuran ) is used for many different inflammatory conditions, including RA. 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.

    Cyclosporine ( Neoral ) 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 RA after other drugs fail and is not in widespread use at this time.

    Tofacitinib (Xeljanz)is a type of drug called a JAK inhibitor. It is often used in people who no longer respond to methotrexate. The drug comes as a pill taken twice a day. But because it inhibits immune responses, Xeljanz adds to a person's risk of serious infections, cancers, and lymphoma. The drug will carry a "black box" warning about these risks.

    DMARDs slow down rheumatoid arthritis and improve quality of life for most people. Some will even achieve a remission while taking them. More commonly, the disease activity continues, but at a slower, less intense pace.

    While taking one or more DMARDs, you may have longer symptom-free periods, or flare ups that are less painful or stressful. Your joints may take less time to loosen up in the morning. At a check-up, your rheumatologist may end up telling you that your most recent X-rays are free of any new damage. Taking a DMARD regularly makes you less likely to have long-term damage to your joints, too.

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