The past 20 years have brought many new ways to treat RA, and there are more around the corner. Here's how the face of treatment has changed.
Then: Twenty years ago, your doctor told you to take over-the-counter or prescription drugs to relieve pain and reduce inflammation. You got a corticosteroid shot. The doctor waited to prescribe stronger medicines -- and choices were limited back then -- until your RA got worse. The approach was to treat flares, not the disease itself.
Nancy Hardin, age 71, of Dyersburg, Tenn., was diagnosed with rheumatoid arthritis (RA) 11 years ago. A few months after her diagnosis, she quit her teaching job at a local high school because she could barely walk. Then she started taking the biologic drug Remicade and became nearly symptom-free. Nevertheless, she decided that going back to the classroom would wear her out. She did, though, become a volunteer translator for local Spanish-speaking immigrants and a member of the Tennessee Council...
Now: You and your rheumatologist tackle RA head-on -- and early. You’ll take powerful medicine from the start -- prescription drugs that work to stop the disease before it causes major damage. There are several to choose from or combine if the first ones don’t work.
Three Categories of Drugs
The formula for treating RA often is a mix. Doctors draw from three main groups of FDA-approved medicines:
1. Nonsteroidal anti-inflammatory drugs (NSAIDs) ease pain and inflammation. Some, like ibuprofen and naproxen sodium, are over-the-counter drugs. You need a prescription for others, including a kind called COX-2 inhibitors, which can be easier on your stomach.
2. Corticosteroids, including prednisone, act quickly to control inflammation. These strong drugs have strong side effects, so doctors limit the dose and how long you take them.
3.Disease-modifying antirheumatic drugs (DMARDs) can alter the course of RA and prevent joint and tissue damage. They block the effects of chemicals released when your immune system mistakenly attacks your joints. Methotrexate is usually the first DMARD prescribed, often as soon as someone is diagnosed. Doctors now know that a delay might make your RA worse.
Thanks to genetics research, many new drugs to treat RA have come online in the past 15 years. Before then, DMARDs were man-made. Most of the newest drugs are biologics, meaning they're made from human genes. These potent copycats may stop an overactive immune system.
Because these drugs target specific steps in the inflammation process, they don’t wipe out your entire immune system, as some other RA treatments do. For many people, a biologic drug can slow, modify, or stop the disease -- even when other treatments haven’t helped much.
The first of a new kind of DMARD, Jakinibs or JAK inhibitors, was approved in 2012. Sometimes called “oral biologics,” they're given as pills rather than as a shot or an infusion, as with the other biologics. Jakinibs work from inside the cells to block the enzymes that alert the immune system to an invader.