Rheumatoid Arthritis Medication: The Right Care

WebMD—July 3, 2007

Don't let RA slow you down. Get the facts about rheumatoid arthritis medications that'll keep you moving.

As recently as 1990, a person diagnosed with rheumatoid arthritis may have been put on Motrin or a pain reliever and sent home. A common notion then was to wait until X-rays showed evidence of joint damage before starting aggressive treatment with rheumatoid arthritis medication. But over the past 15 years, experts have learned that early aggressive treatment is essential to help prevent long-term damage and disability from rheumatoid arthritis.

Rheumatoid Arthritis Medication: Live Longer, Live Better

Many people think of rheumatoid arthritis as a debilitating chronic disease, but not necessarily a deadly one. Yet people with RA have been found to have a life expectancy that's shorter than people without the disease. That's largely because they're at increased risk for other conditions, like heart disease, renal disease, infections, and respiratory problems.

Rheumatoid arthritis medication can do more than just keep you from being disabled—it may add years to your life.

Several major studies have documented the dramatic benefits of early treatment with rheumatoid arthritis medication. Research presented at the 2006 American College of Rheumatology Annual Scientific Meeting found that early, intensive treatment with a combination of rheumatoid arthritis medication offers a chance of remission.

So how early should you begin treatment with rheumatoid arthritis medication?

"It's never too early, and never too late—there's plenty of data that even treating late does help, so don't despair if you didn't receive early treatment," says Theodore R. Fields, M.D., FACP, clinical director of the Gosden-Robinson Early Arthritis Center at New York's Hospital for Special Surgery. "But clearly there's a dramatic benefit of getting in there early to get the disease controlled."

Rheumatoid Arthritis Medication: A Range of Options

People with rheumatoid arthritis have a broad range of options for treatment, and doctors may try several rheumatoid arthritis medication combinations before they find the one that works best for you. Rheumatoid arthritis medications include:

• DMARDs (disease modifying antirheumatic drugs), can slow, and sometimes even prevent, joint damage and destruction associated with rheumatoid arthritis. They include leflunomide (Arava), sulfasalazine (Azulfidine), hydroxychloroquine (Plaquenil), and methotrexate. Methotrexate is the most commonly prescribed first-line treatment for RA because it provides quick relief and has a relatively low rate of side effects.
• Biologic DMARDs (such as TNF blockers) is a newer group of drugs derived from living organisms. These medications interfere with the activities of cytokines, an element of the immune system that can fuel or suppress inflammation. They include Enbrel, Humira, Kineret, Remicade, and Rituxan.
• Corticosteroids: They may reduce some joint damage by reducing inflammation, but their limited effectiveness and high rate of side effects do not make corticosteroids a good long-term treatment strategy.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): these drugs, such as ibuprofen and Motrin, relieve symptoms and mild inflammation but do not have any modifying effect on the disease itself.

Rheumatoid Arthritis Medication: Side Effects

Something to keep in mind: RA drugs, particularly the synthetic and biologic DMARDs, do not come without side effects.

Methotrexate, for example, can suppress your body's immune system—it's used in larger doses in cancer chemotherapy. The biologic DMARDs can also weaken the immune system and have been linked to increased rates of infection and certain cancers.

What to Expect From Treatment With Rheumatoid Arthritis Medication

When treating patients, "our number one goal is remission," says Dr. Fields. "We can't always get there, but that's our goal, and in 23 years of practice, I've never seen more people coming back and saying 'I've forgotten I have arthritis' than I do today. That's still a minority, but most people come back and have some degree of improvement that often allows them to function socially, work, participate in sports, and have a pretty normal life even though they have some swelling and stiffness."

Patients need to be more educated than ever before when it comes to RA.

"You have to be involved. There's no room for the doctor to just say, 'You have rheumatoid arthritis, and I'm writing you a prescription for this,'" says Dr. Fields. "There are so many options and so many issues individual to the patient. Doctor-patient collaboration is essential."