How Doctors Treat Rheumatoid Arthritis

Even if your rheumatoid arthritis (RA) is mild, the sooner you start treatment, the better. One of the key goals is to tame inflammation.

Almost everyone with rheumatoid arthritis takes medicine for it. But there are different kinds.

Some drugs help control the disease and limit joint damage. Others ease pain and inflammation but don’t curb joint damage. You may take more than one type of drug. If your joint damage is severe, you may need joint replacement or other surgeries. Use this guide to get to know what your doctor may recommend.

DMARDs

Examples: These medications include hydroxychloroquine (Plaquenil), leflunomide (Arava), methotrexate (Trexall), and sulfasalazine (Azulfidine). Your doctor will call them “DMARDs,” which stands for disease-modifying antirheumatic drugs. Anyone diagnosed with RA should start taking at least one DMARD immediately, usually methotrexate, no matter how mild their disease.

Tofacitinib (Tofacitinib, Xeljanz) is different because unlike other DMARDs, it affects a specific part of the immune system involved in RA. It also makes you more likely to get a serious infection. Your doctor may try it or another drug if methotrexate doesn’t work.

What they do: They work in different ways to curb your immune system.

How you take them: You can take them as a pill, although some people get methotrexate as an injection. It may take from 4 to 6 weeks to a few months for them to start to work, and longer to reach their full effect.

Side effects: These vary with each medicine. Serious ones include infection and kidney or liver damage. Leflunomide and Methotrexate can cause birth defects. If you're planning to start a family, talk with your doctor first.

Biologic Drugs

Examples: abatacept (Orencia), adalimumab (Humira), adalimumab-atto (Amjevita), a biosimilar to Humira, anakinra (Kineret), certolizumab pegol (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Inflectra, Remicade), infliximab-abda (Renflexis) or nfliximab-dyyb (Inflectra), biosimilars to Remicade, rituximab (Rituxan), and tocilizumab (Actemra).

What they do: Biologics target specific parts of your immune system to turn down inflammation. These drugs can work quickly to reduce joint pain and swelling. Over time, they can slow down joint damage and help your joints move better. Doctors use biologics to treat moderate to severe RA that methotrexate or other DMARDs don’t control.

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Many biologics block TNF, a chemical your body makes that causes inflammation. Other biologics target other chemicals, like IL-1, IL-17, or Janus kinase (JKA) or immune system cells (like T or B cells).

How you take them: You may take biologics by injection at home, by IV in a medical center, or as a pill. Depending on what you need, you may take one on its own or with other types of RA drugs.

Side effects: Because they slow down your immune system, biologics make it harder for your body to fight infection. They can cause flare-ups of some infections that aren't active, like tuberculosis. Some people have reactions at the IV or injection site.

More widespread IV reactions may include chest pain, trouble breathing, and hives. Each drug has its own set of side effects that you should talk about with your doctor.

Corticosteroids

Examples: They’re often just called “steroids." There are lots of them. Common ones include hydrocortisone, methylprednisolone, and prednisone.

What they do: These drugs are strong inflammation fighters. They can quickly improve symptoms and ease swelling. They’re less effective at slowing RA itself. Your doctor may prescribe them to get inflammation under control or when you have a flare. For some people, a low dose of steroids plus DMARDs or biologics controls their RA.

How you take them: You can take some by mouth. Others you get as a shot.

Side effects: Steroids can cause weight gain and bone loss, making osteoporosis more likely. They also may worsen diabetes and raise the chance of infections. Generally, lower doses taken for a shorter time means fewer side effects.

NSAIDs

Examples: celecoxib (Celebrex), ibuprofen, and naproxen

What they do: Lower inflammation and help relieve pain. They don’t slow joint damage.

How you take them: Many NSAIDs come as pills or tablets. Some need a doctor’s prescription. Others are sold “over the counter,” which means you don’t need a prescription for them.

Side effects: NSAIDs can cause stomach problems, including bleeding. Some also have been linked to a greater chance of having heart disease and should be used with caution in people who already have heart, liver, or kidney disease.

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Joint Replacement Surgery

If your joint damage is severe, causes pain, and makes it hard for you to move, your doctor may recommend joint replacement surgery. When you talk about it, you may want to ask:

  • What are the pros and cons?
  • What are the possible complications?
  • How long will it take to recover?
  • Will I need physical therapy?

 

WebMD Medical Reference Reviewed by Minesh Khatri, MD on October 02, 2017

Sources

SOURCES:

American College of Rheumatology: “Patient fact sheet: rheumatoid arthritis,” “Patient Education: Biologic Treatments for Rheumatoid Arthritis,” “Position statement: biologic agents for rheumatic diseases.”

Douglas Conaway, MD, rheumatologist, Carolina Health Specialists, Myrtle Beach, SC.

FDA: “FDA approves Inflectra, a biosimilar to Remicade,” “FDA approves Amjevita, a biosimilar to Humira.”

Johns Hopkins Arthritis Center: “Rheumatoid Arthritis Treatment.”

National Institute of Arthritis and Musculoskeletal and Skin Diseases: “Questions and Answers About Hip Replacement,” “Handout on Health: Rheumatoid Arthritis.”

Seth Mark Berney, MD, professor, department of medicine; director, Center of Excellence for Arthritis and Rheumatology, Louisiana State University Health Sciences Center, Shreveport.

Smolen J. Annals of the Rheumatic Diseases, 2010.

Theodore Pincus, MD, clinical professor of medicine, Division of Rheumatology, New York University School of Medicine, New York.

Thomas Hardin, vice president for research, Arthritis Foundation.

UpToDate: "Assessment of rheumatoid arthritis activity in clinical trials and clinical practice," “Clinical features of rheumatoid arthritis,” “General principles of management of rheumatoid arthritis,” “Patient information: disease modifying antirheumatic drugs (DMARDs),”“Overview of biologic agents and kinase inhibitors in the rheumatic diseases.”

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