Frequently Asked Questions About Rheumatoid Arthritis
Treating Rheumatoid Arthritis
Why is it important to start treatment early?
Early, aggressive treatment for rheumatoid arthritis is important not only to relieve symptoms and make you more comfortable now, but to help prevent serious problems later – particularly if blood tests indicate you are at risk of developing a more serious form of the disease.
Doctors generally agree that your risk of serious disease is greater if blood tests are positive for antibodies to rheumatoid factor (RF) or cyclic citrullinated proteins (anti-CCP). While not all people with RA test positive for these antibodies, a positive test can indicate that you need more aggressive treatment to help keep the disease from progressing.
Fifteen or 20 years ago, doctors started treatment for virtually all RA patients with aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) to ease pain and inflammation, and progressed to stronger disease-modifying antirheumatic drugs (DMARDs) if symptoms persisted. Today, however, research shows that that irreparable damage can occur early in the disease process, so doctors make every attempt to treat aggressively early on to slow or even stop that process before damage occurs.
If you are not receiving treatment, or if you’re not being treated aggressively, you risk damage to your joints that could lead to deformity and disability – and possibly necessitate joint replacement surgery – down the road.
Aggressive treatment usually involves a disease-modifying antirheumatic drug such as methotrexate, hydroxychloroquine (Plaquenil), sulfasalazine (Azulfidine); a biologic agent such as etanercept (Enbrel) or adalimumab (Humira), or a combination of both a biologic and a DMARD.
What medications are used to treat rheumatoid arthritis?
There are many different drugs used in the treatment of rheumatoid arthritis. Some are used primarily to ease the symptoms of RA; others are used to slow or stop the course of the disease and to inhibit structural damage. Most of these drugs fall into one of the following categories:
NSAIDs – Nonsteroidal anti-inflammatory drugs include more than a dozen different medications – some available over-the-counter, some available by prescription only – used to help ease arthritis pain and inflammation. NSAIDs include such drugs as ibuprofen (Advil, Motrin), ketoprofen (Actron, Orudis KT) and naproxen sodium (Aleve), among others. If you have had or are at risk of stomach ulcers, your doctor may prescribe celecoxib (Celebrex), a type of NSAID called a COX-2 inhibitor, which is designed to be safer for the stomach.
Corticosteroids – Corticosteroid medications, including prednisone, prednisolone and methyprednisolone, are potent and quick-acting anti-inflammatory medications. They may be used in RA to get potentially damaging inflammation under control, while waiting for NSAIDs and DMARDs (below) take effect. Because of the risk of side effects with these drugs, doctors prefer to use them for as short a time as possible and in doses as low as possible.
DMARDs – An acronym for disease-modifying antirheumatic drugs, DMARDs are drugs that work slowly to actually modify the course of the disease. In recent years, the most commonly used DMARD for rheumatoid arthritis is methotrexate. But there are about a dozen others that fall into this category. They include hydroxycholorquine (Plaquenil), sulfasalazine (Azulfidine, Azulfidine EN-Tabs), leflunomide (Arava) and azathioprine (Imuran). A person diagnosed with RA today is likely to be prescribed a DMARD fairly early in the course of their disease, as doctors have found that starting these drugs early on can help prevent irreparable joint damage that might occur if their use was delayed.
Biologic agents – The newest category of medications used for rheumatoid arthritis is that of the biologic agents. There are currently six such agents approved for rheumatoid arthritis: abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), etanercept (Enbrel), infliximab (Remicade) and rituximab (Rituxan). Each of the biologics blocks a specific step in the inflammation process. Humira, Enbrel and Remicade block a cytokine called tumor necrosis factor-alpha (TNF-?), and therefore often are called TNF-? inhibitors. Kineret blocks a cytokine called interleukin-1 (IL-1). Orencia blocks the activation of T cells. Rituxan blocks B cells. Because these agents target specific steps in the process, they don’t wipe out the entire immune response as some other RA treatments do, and in many people a biologic agent can slow, modify or stop the disease – even when other treatments haven’t helped much.
For more information, see Arthritis Today's Drug Guide.
What are the side effects?
All medications – even ones you buy without a prescription – have the potential for side effects. Arthritis medications are no exception.
It is impossible to list all of the side effects of arthritis medications because different drugs cause different side effects and different people react differently to medications. However, some of the more common side effects of the different categories of medications used to treat arthritis are:
Nonsteroidal anti-inflammatory drugs (NSAIDs) – Edema (swelling of the feet) heartburn, stomach upset and stomach ulcers and possibly increased risk of blood clots, heart attack and stroke.
Cortiocosteroids – Cataracts, elevated blood fats and blood sugar levels, increased appetite and bone loss.
Disease-modifying antirheumatic drugs (DMARDs) – Stomach upset and increased susceptibility to infection. Other side effects vary by drug.
Biologic agents – Injection or infusion site reactions, including redness and swelling, and increased risk of serious infections. Other side effects vary by drug.
When prescribing medications, you and your doctor will need to weigh the potential risks against the benefits you hope and expect to achieve.
You should speak with your doctor about ways to minimize medication side effects, such as adjusting the dosage or timing of medication, taking it with food or taking another medication to counteract the side effect.
For more information, see Arthritis Today's Drug Guide.
If I’m in remission, can I stop taking medication?
Although it may be tempting to stop taking medications when you’re in remission and feeling good, in most cases, no, you should not stop taking medication.
While stopping medication may not cause problems for the first few weeks or even a few months, in most patients, a relapse is almost always inevitable. In addition, getting the disease back under control will often be more difficult.
The best strategy is to be consistent with your treatment. If It’s working, keep it up.
In some cases, your doctor may reduce your dose or perhaps change a medication when your disease is under control. But you should never stop a treatment without first consulting your doctor.
What new treatments are being developed?
A growing understanding of how the immune system works and what goes awry in rheumatoid arthritis is helping scientists develop agents that interfere with or enhance certain steps of the process. Several of these agents – referred to a biologic response modifiers or biologics – are already on the market and dramatically improving the lives of many people for whom other RA therapies failed to control the disease.
• inhibit tumor necrosis factor-alpha (TNF-alpha). , a protein that causes damaging inflammation. Although there are three TNF-α inhibitors already on the market , scientists hope to develop additional agents that will require less frequent injections or that can be taken orally.
• block interleukin-6 (IL-6), a protein that works with TNF-alpha to cause inflammation
• block interleukin-15 (IL-15), a protein that attaches to receptors on cells to activate inflammatory process in the joint lining
• reduce the number of inflammation-causing immune system cells called B cells. One such agent, ribuximab (Rituxan), is already approved for RA.
Researchers are also investigating the effectiveness of drugs already approved for other illnesses, such tacrolimus (Prograf), a drug developed and approved for preventing organ rejection in people who have received liver or kidney transplants; cholesterol-lowering drugs called statins; and a class of medications called bisphosphonates, used to slow bone loss in osteoporosis.
You may learn about new or potential drugs on the news, in publications such as Arthritis Today or read reports on the Internet. When you hear about a drug that has just been approved by the FDA, ask your doctor or other health professional if it is a potential treatment.
Get more information on new biologics in the pipeline.
Are there any “natural” supplements that can treat rheumatoid arthritis?
People who are frustrated with conventional medications for RA may be attarcted to herbs, supplements and other natural remedies.
While natural treatments are appealing, it’s important to note that natural doesn’t always mean safe. Some people think that supplements – especially herbs – are safe because they are natural alternatives to the chemicals in prescription drugs. But herbs, too, are chemicals. And anything strong enough to help also may be strong enough to hurt.
That said, there are some extracts and supplements that have been useful in treating various types of arthritis. For example, research shows that taken in large quantities, the omega-3 fatty acids found in oils from certain fish modify inflammation associated with RA. Other research has shown that oil extracted from the borage plant has properties similar to nonsteroidal anti-inflammatory drugs (NSAIDs) without the gastrointestinal side effects. However, researchers have not yet determined the effective dosages and long-term side effects of these supplements.
Although many supplements are touted to help RA, the fact is, for most supplements, solid scientific evidence is not available.
For more information – including legitimate studies – on herbs and supplements, consult the Web site of the National Center for Complementary and Alternative Medicine, part of the National Institutes of Health. You can also find information about herbs and supplements used for arthritis in Arthritis Today's Supplement Guide.
Can I be cured?
Unfortunately, there is no cure for rheumatoid arthritis – at least not yet – but finding a cure is certainly a goal for researchers. In the meantime, there are many things you can do to control RA and limit its impact on your life. Today, it is easier than ever to control RA through the use of new drugs, exercise, joint protection techniques and self-management techniques.
Taking Control of Rheumatoid Arthritis
What can I do to take control of my rheumatoid arthritis?
Can I exercise with rheumatoid arthritis?
Can certain foods help or hurt my rheumatoid arthritis?
What the Future May Hold
Will I be able to have a baby?
Will my child be at risk for rheumatoid arthritis?
Does having rheumatoid arthritis put me at risk for other diseases?
About Rheumatoid Arthritis
What is an autoimmune disease?
What causes rheumatoid arthritis?
Getting Diagnosed
How is rheumatoid arthritis diagnosed?
What kind of doctor should I see for rheumatoid arthritis?
Back to Focus on RA
