Arthritis: Disease-Modifying Medications

There are a variety of medications that work by altering the immune system function to halt the underlying processes that cause certain forms of inflammatory arthritis including rheumatoid arthritis (RA), >ankylosing spondylitis, and psoriatic arthritis. These are called disease-modifying antirheumatic drugs or DMARDs for short.

These drugs not only treat arthritis symptoms, but they also can slow down progressive joint destruction.

Many types of drugs are DMARDs. Traditional drugs of this type include:

• Anti-malaria medications, particularly Plaquenil
• Organ antirejection drugs, such as cyclosporine
• Miscellaneous drugs, such as Azulfidine and gold
• Chemotherapy drugs, such as methotrexate, Imuran, and Cytoxan
• Arava

The most commonly used DMARD is methotrexate. For more information, see the article on methotrexate and other chemotherapy drugs used for arthritis. This article concentrates on other DMARDs. For more on biologics, see the article on new arthritis treatments.

Some of these medications are traditionally used to treat other conditions such as cancer or inflammatory bowel disease, or to reduce the risk of rejection of a transplanted organ. However, when chemotherapy medications (such as methotrexate or Cytoxan) are used to treat rheumatoid arthritis, the doses are significantly lower and the risks of side effects tend to be considerably less than when prescribed in higher doses for cancer treatment.

Over the past several years, researchers have developed newer DMARDs that more specifically target the immune system and have fewer side effects. These are called biological response modifiers or biologics. They include: Enbrel, Humira, Kineret, and Remicade.

Arava helps calm the inflammation associated with rheumatoid arthritis. Arava interferes with genes in developing cells, like those of the immune system. Yet It isn't completely clear how this drug works to help rheumatoid arthritis.

Arava is a pill that is taken in a dose of 10 or 20 mg once a day. Because it builds up in the body very slowly, it is necessary to take a loading dose of 100 mg daily for two or three days in order to speed up the treatment. This loading dose is followed by the 10 or 20 mg daily dose. Arava can be taken on an empty stomach or with meals.

Studies on Arava suggest these possible side effects: rash, reversible hair loss, irritation of the liver, nausea, diarrhea, and abdominal pain. When taking Arava, it is necessary to have periodic blood tests, as recommended by your doctor, to detect liver irritation.

Arava is not recommended for people who have liver disease, pregnant or nursing women, or people with immune systems weakened by an immune deficiency or disorder.

Since Arava might cause birth defects, both men and women should use a reliable method of birth control while being treated with this medication. If a woman taking Arava wishes to become pregnant, she should stop the Arava, take a medication called cholestyramine for 11 days to get all the Arava out of the body, and then have a blood test to prove that the drug is gone. Less is known about the effects of Arava on men planning to father children. To be safe, men should consider cholestyramine treatment before attempting to conceive.

Plaquenil is a drug used to treat malaria. It was discovered that it worked for arthritis when people taking the drug for malaria reported improvements in their arthritis. The drug affects the immune system, although doctors do not know exactly how it works.

Usually Plaquenil is used when other RA treatments fail. It can be given along with steroid treatment to reduce the amount of steroid needed. It is also given to treat the facial rash of lupus.

Plaquenil is given by mouth daily. Side effects include low white blood cell counts, blood or protein in the urine, nausea, and skin rashes. High doses can rarely cause injury to the back of the eye; therefore, patients on this drug should see an eye doctor every six to 12 months.