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Treating Rheumatoid Arthritis With Disease-Modifying Drugs (DMARDs)

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DMARD Side Effects and Use continued...

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 RA after other drugs fail.

Imuran (azathioprine) 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.

Xeljanz (tofacitinib) 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.

Are DMARDs Safe?

The FDA has approved all DMARDs. Many people take them without ever having problems.

But because they work throughout the body to fight RA, their powerful action typically does cause some side effects, commonly:

  • Stomach upset. DMARDs often cause nausea, sometimes with vomiting, or diarrhea. Other medicines can help treat these symptoms, or they often improve as you get used to the drug. If the symptoms are too uncomfortable to tolerate, your rheumatologist will try a different medication.
  • Liver problems. These are less common than stomach upset. Your doctor will check blood tests on a regular basis to make sure your liver is not being harmed.
  • Blood issues. DMARDs can affect the immune system and raise the risk of infection. Infection-fighting white blood cells may also be decreased. Low red blood cells (anemia) can make you tired more easily. A simple blood test by your doctor every so often will make sure your blood counts are high enough.

You should learn about possible side effects of any medicine you are taking and discuss them with your doctor until you feel comfortable.

To minimize side effects, DMARDs are sometimes started one at a time and increased gradually. The goal is to minimize both rheumatoid arthritis disease activity and medication side effects. Sometimes it takes more than one DMARD to get control of active rheumatoid arthritis. 

WebMD Medical Reference

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