Arthritis: Disease-Modifying Medications
Cyclosporine is a tablet that's best known as a drug to prevent rejection of transplanted organs. It works by stopping an overactive immune system from attack. Therefore, it can be effective in stopping joint inflammation and destruction caused by RA. It's not used frequently due to the availability of more effective and less toxic medications
The side effects include high blood pressure, headache, kidney problems, nausea, diarrhea, and heartburn. Regular blood count testing is mandatory.
Azulfidine (sulfasalazine) is used for treatment of rheumatoid arthritis, arthritis associated with ankylosing spondylitis, and arthritis associated with inflammatory bowel diseases such as ulcerative colitis and Crohn's disease. It may be used alone or in combination with other medications. People allergic to sulfa drugs should not take Azulfidine. Side effects include rash, headache, changes in blood counts, and nausea or vomiting.
The most commonly used DMARD is methotrexate. Since the early 1980s, methotrexate has gained prominence as an effective first-line treatment for RA. It also has advantages in having dose flexibility, as higher doses may be used for worse disease, and it is easy to monitor for side effects by testing for liver function and blood counts. It is often used in combination therapy for RA as well.
Side effects of methotrexate include rash, mouth sores, hair loss, fatigue, liver damage, lung damage, and bone marrow toxicity. The risk of side effects can be reduced by taking daily folic acid.
Imuran (azathioprine) is drug that has also been used for cancer and organ transplants. It can be effective for RA, particularly for complications such as vasculitis. It is an oral tablet. Side effects include nausea, vomiting, rash, mouth sores, liver and blood count abnormalities, and increased risk of infection. Regular blood test monitoring is mandatory.
Cytoxan (cyclophosphamide) is a powerful immune suppression medication. Cytoxan is used only for serious complications of RA, such as vasculitis or inflamed lungs. Cytoxan can cause hair loss, oral sores, fatigue, bone marrow suppression, and increased risk of infection. Regular blood test monitoring is mandatory.
Actemra, Cimzia, Enbrel, Humira, Kineret, Orencia, Remicade, Rituxan, and Simponi are among the newest treatments for rheumatoid arthritis, and are given by injection or IV infusion. They work by affecting the immune system's signals that lead to joint damage. They are often used in combination with methotrexate or other DMARDs. One side effect is the increased risk for potentially severe infections. These drugs can also cause skin reactions and affect blood counts, and they 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.