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.
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 20 years. Before then, DMARDs were manmade. Most of the newest drugs are biologics, which are made from a living organism and include antibodies, interleukins, and vaccines. 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 an “oral biologic,” this medicine is available as a pill 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.
While there are more choices than ever to treat RA, researchers also have found new promise in some old treatments.
Recent studies show that some of the first DMARDs -- hydroxychloroquine (Plaquenil), methotrexate (Otrexup, Rheumatrex, Trexall), and sulfasalazine (Azulfidine, Azulfidine EN-tabs) -- when combined, may work as well as methotrexate plus a biologic. This “triple therapy,” as it's called, gives you and your doctor another approach if methotrexate alone is not working. It's also an option if you're wary of biologics because of their side effects or high cost.
Promise for the Future
There’s still much to learn about why and how RA happens. Building on recent discoveries, areas under study include:
- Researchers are looking at genes to see why some people get RA and some don’t, and why some cases are worse than others. This data can lead to biologics -- like JAK inhibitors -- that fight the causes of RA at a cellular level. Several such drugs are in the works.
- Medical and dental researchers are revisiting the link between joint disease and gum disease.
Discoveries have made it possible for you to remain active and work much longer than was possible 20 years ago. Scientists are thinking about RA in exciting new ways, and the next generation of treatments shows great promise.