How to Manage Side Effects of RA Medications

Medications for your rheumatoid arthritis could have side effects, but there are steps you can take to manage them. Whether you have nausea, rashes, or gain a few pounds, changes in your diet and lifestyle can help. Your doctor can also tweak your treatment to give you some relief.

How to Learn About Your Medicine's Side Effects

When you get a new prescription, talk to your doctor or pharmacist about what to expect. Some questions to ask about side effects:

  • What are the common ones for my drug?
  • Will I have them right away or later?
  • Will the problems improve over time?
  • What can I do to manage them?
  • Are any of them serious?
  • Is it OK if I drink alcohol or get pregnant while I take this medication?

Also, check your prescription's insert sheet, which lists possible side effects. Keep in mind, though, that you may not have all or most of these problems.

Your medicine's package insert or bottle label also offers you some basic tips to follow that may help prevent side effects. For example, it may tell you to take your pills with food so that you won't feel nauseated.

NSAIDs

What they do: Nonsteroidal anti-inflammatory drugs (NSAIDs) ease your joint pain and inflammation. They include:

  • Ibuprofen
  • Naproxen
  • Aspirin
  • Diclofenac
  • Ketoprofen
  • Celecoxib

Common side effects: While most people only feel mild side effects while on these drugs, NSAIDs other than celecoxib may cause stomach upset, heartburn, or even an ulcer. NSAIDs other than aspirin may raise your chance of having heart disease, heart attacks, or strokes.

What you can do: For stomach problems, take your medicine after a meal or with an antacid. Limit the amount of alcohol you drink. If that doesn't help, your doctor can prescribe another drug to lower stomach acid or switch you to celecoxib.

Serious side effects: If you get severe pain, or black or bloody stool, it could be a sign of bleeding inside your body. Hives, rash, dizziness, or blurred vision could mean you're getting a serious allergic reaction to your drug. Don't take another dose, and call your doctor.

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Steroids

What they do: They ease inflammation, swelling, and pain. You might take a course of them if you have an RA flare. Steroids include:

  • Prednisone
  • Hydrocortisone
  • Methylprednisolone
  • Dexamethasone

Common side effects: You could get high blood pressure, gain weight, or have mood changes and sleep problems. Also watch out for nausea or stomach pain, glaucoma or cataracts, and fluid buildup in your legs. Other side effects are:

  • Weak bones or osteoporosis
  • Bruises
  • High blood sugar
  • Higher risk of infections

You're more likely to have side effects on higher doses or if you take steroids for a longer time.

What you can do: If you smoke, quit. Eat a healthy diet that's lower in salt, and get regular exercise. It will help you keep your weight under control and your bones and muscles strong. Calcium supplements or foods like yogurt help protect your bones.

If steroids bother your stomach, take them with a full meal or an antacid.

Get eye exams to check for glaucoma or cataracts, a yearly flu shot, and checkups to watch your blood pressure and blood sugar. If you find it hard to sleep, ask your doctor if you can take your whole dose in the morning.

Serious side effects: High fever, cough with mucus, painful urination, or skin boils could be a sign of infection. Call 911 or your doctor right away.

If you have hip pain but your RA doesn't affect your hip, your steroids could have damaged your bone. Let your doctor know.

DMARDs

What they do: Disease-modifying antirheumatic drugs (DMARDs) treat your inflammation, pain, and swelling. They also make changes to your immune system -- your body's defense against germs -- to help slow RA's effects.

Methotrexate is the first RA treatment most people take. Other DMARDs include:

  • Azathioprine
  • Hydroxychloroquine
  • Leflunomide
  • Sulfasalazine
  • Cyclosporine

Common side effects: Some things that you may notice are nausea and vomiting. You could also be at risk for bleeding inside your body, infection, sores in your mouth, and birth defects if you're pregnant.

Methotrexate can harm the way your liver works. Hydroxychloroquine may damage your eye's retina. Sulfasalazine may make your sweat, tears, or urine look orange, and your skin more sensitive to sunlight.

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What you can do: Take methotrexate and other DMARDs after meals so you won't feel as nauseated.

If you take methotrexate, don't drink alcohol. Take folic acid supplements to ease nausea, mouth sores, and liver problems. Your doctor will test your liver at checkups.

You may be able to switch to injectable methotrexate if pills bother your stomach. Use birth control, and plan ahead for a pregnancy.

Get regular eye exams if you're on hydroxychloroquine. Drink plenty of water, and use sunscreen or cover up if you take sulfasalazine.

Serious side effects: Call your doctor right away if you see signs of infection. Get checked if you see blood in your gums or urine, purple spots on your legs, bloody or black stool, rash, yellow eyes or skin, or if you have trouble breathing, feel dizzy, or have unusual fatigue. 

Biologics

What they do: Biologic drugs stop RA inflammation. They target your immune system, slow it down, and block its attack on your joints and organs.

Biologics for RA include:

  • Abatacept
  • Adalimumab
  • Anakinra
  • Certolizumab pegol
  • Etanercept
  • Golimumab
  • Infliximab
  • Rituximab
  • Tofacitinib
  • Tocilizumab

Common side effects: You may get infections, headaches, nausea, redness around the injection site, or allergic reactions.

If you take these drugs as an infusion, you can have nausea or vomiting, low blood pressure, skin reactions, or trouble breathing.

Less common side effects include:

  • Vision problems
  • Numbness or tingling
  • Rash on your face or sun sensitivity
  • Swollen hands or ankles
  • Shortness of breath
  • Heart failure
  • Serious infections

What you can do: Press a cool cloth on the site of your injection or put steroid cream on your skin to ease a reaction there.

Wash your hands often and avoid crowded places to lower your risk of infections. Don't share cups or utensils. Avoid raw foods like oysters.

Press a cold compress to your head to ease headaches. Sip cool water, nibble a cracker, or lie in a cool, dark room to get relief from nausea.

Serious side effects: Call your doctor right away if you notice signs of infection. Get medical help right away if you have chills, shortness of breath, redness, rash, swollen lips or hands, or itching. These are signs of a serious allergic reaction.

WebMD Medical Reference Reviewed by David Zelman, MD on December 13, 2018

Sources

SOURCES:

Center for Advancing Health: "Side Effects: When Silence Isn't Golden."

Hospital for Special Surgery.

Arthritis Foundation.

University of Pittsburgh Medical Center: "Questions All Patients Should Ask Their Pharmacist About Their Medications."

UpToDate: "Patient Education: Disease-Modifying Antirheumatic Drugs (DMARDs)."

MotherToBaby.org: "Methotrexate and Pregnancy."

Johns Hopkins Arthritis Center: "Side Effects of Biologic Medications."

American College of Rheumatology.

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