You can't miss the telltale signs: painful and swollen joints that get worse over time. Painkillers and drugs that fight inflammation can treat your rheumatoid arthritis symptoms. But if you want to slow the disease down, you'll need to turn elsewhere. Your doctor may suggest medicine that tries to get at the root of your trouble -- an immune system that's gone a little haywire.
DMARDs
These drugs slow RA's course. You may hear your doctor call them by their full name -- disease-modifying anti-rheumatic drugs.
When you have rheumatoid arthritis, your immune system -- the body's defense against germs -- attacks healthy joints by mistake. DMARDs can help control this process. They won't give you immediate relief, but over time, they can ease your pain, swelling, stiffness, and fatigue.
Usually, the first DMARD your doctor will prescribe is methotrexate (Otrexup, Rheumatrex, Trexall, Rasuvo, Xatmep). You can take it as a pill or give yourself a shot. It may ease pain and swelling in your joints and make complications less likely. You'll have to get regular blood tests to make sure the drug doesn't harm your liver or reduce blood counts.
Other DMARDs that slow inflammation and RA's progression include:
- Hydroxychloroquine (Plaquenil)
- Leflunomide (Arava)
- Sulfasalazine (Azulfidine, Salazopyrin, Sulfazine)
Doctors often prescribe these medications in combinations.
Biologics
If your disease is more severe, or if traditional DMARDs don't help, your doctor might have you try a type of DMARD called a biologic. These strong drugs target specific substances in your immune system that cause inflammation.
There are a couple of ways to use them. You might give yourself a shot at home or get them through an IV while you're at the doctor's office. You might need to combine biologics with methotrexate to get better results.
These drugs can slow RA's activity in your body so you feel better. They also help slow joint and organ damage.
Biologics include:
- Abatacept (Orencia)
- Adalimumab (Humira)
- Adalimumab-adbm (Cyltezo) , a biosimilar to Humira
- Adalimumab-atto (Amjgvita), a biosimilar to Humira
- Anakinra (Kineret)
- Baricitinib (Olumiant)
- Certolizumab pegol (Cimzia)
- Etanercept (Enbrel)
- Etanercept-szzs (Erelzi), a biosimilar to Enbrel
- Golimumab (Simponi, Simponi Aria)
- Infliximab (Remicade)
- Infliximab-abda (Renflexis), a biosimilar to Remicade
- Infliximab-dyyb (Inflectra), a biosimilar to Remicade
- Rituximab (Rituxan)
- Sarilumab (Kevzara)
- Tocilizumab (Actemra)
- Tofacitinib (Xeljanz)
- Upadacitinib (Rinvoq)
Doctors often recommend that you combine a biologic with a DMARD.
Because biologics affect your immune system, you may be more likely to get an infection and certain cancers. It's also important to watch for things like fever, cough, diarrhea, or nausea. You may also get a skin reaction on parts of your body where you give yourself shots.
Targeted Synthetic DMARDs
If you don’t respond well to other medications, your doctor might try another treatment called a JAK inhibitor. These drugs block a pathway in your body’s immune response. You usually take them as a pill. Your doctor might try:
- Tofacitinib (Xeljanz)
- Baricitinib (Olumiant)
- Upadacitinib (Rinvoq)
Their side effects are similar to those of biologics: a higher risk of infections and some cancers. As with those medications, watch out for fever, cough, and stomach problems.
Track Your Progress
To find out how well your meds are working, your doctor may count how many of your joints are stiff or painful at each office visit. They may also do blood tests to measure cells to see the extent of your inflammation. Periodic X-rays or ultrasounds help to track damage to the joints. All of this information tells your doctor how active your RA is and helps find out if your treatment is working well.
Tell your doctor if you get any side effects. If they're serious, they may try a different drug or change your dosage.
