Rheumatoid arthritis (also called RA) is a type of autoimmune disease that destroys healthy tissue, specifically the synovial membrane. This membrane lines the capsules that surround joints and produces synovial fluid, which lubricates the joint surfaces and allows them to smoothly glide over each other during movement.1 Synovial fluid also acts as a shock absorber and reduces the impact of pressure on the joins.
Rheumatoid arthritis causes inflammation in the synovial membrane, which results in pain and swelling. As a response to the inflammation, the affected area attracts increased blood flow, which contributes to redness, warmth, and further swelling. The inflammatory cells in the synovial membrane release enzymes, which irritate the joints (causing more pain) and eventually digest the surrounding bone and cartilage. This leads to the deformity of the affected area and loss of normal function.
Rheumatoid arthritis does not only affect joints since it can also cause inflammation in the eyes, skin, lungs, and other parts of the body.2 Fortunately, this disease can be effectively managed with the right medications and therapy, particularly if patients receive early treatment.3
Rheumatoid Arthritis Medications
Several types of drugs have been found out to be effective in treating rheumatoid arthritis. They can be taken on their own, but they are usually prescribed in tandem to increase their effectiveness and alleviate the symptoms that patients experience.
Nonsteroidal anti-inflammatory drugs or NSAIDs can help manage pain and inflammation.4 They’re especially helpful for those who have moderate or severe rheumatoid arthritis. NSAIDs do not slow down the progression of the disease, which is why they are usually paired with other medications that help prevent bone and cartilage damage.
Patients can take over-the-counter NSAIDs such as aspirin, naproxen, and ibuprofen. However, these are often not enough to reduce pain, which is why stronger NSAIDs are usually prescribed to those with rheumatoid arthritis.
It’s important to note that NSAIDs have many side effects and adverse effects, and they can be dangerous to those that have other illnesses aside from RA. They can cause stomach irritation, ulcers, and bleeding, which means they must be used with caution in patients with gastrointestinal problems.5
COX-2 inhibitors, a type of NSAIDs, increase the risk of myocardial infarction and other cardiovascular problems, and they should be prescribed with caution in patients with existing cardiovascular risk factors.6
Oral and injectable corticosteroids can help reduce inflammation and are therefore an important part of the treatment regimen for rheumatoid arthritis. They are often given as a temporary medication to patients who experience flares or when the symptoms of RA become worse than usual.7 In these cases, steroids can help reduce the severity of pain and stiffness that flares bring and help patients return to their normal level of activity.
Corticosteroids can also be given as first-line treatment to patients who have just been diagnosed with rheumatoid arthritis. They help keep pain and inflammation under control while patients wait for NSAIDs and DMARDs to take effect.8 They’re also the treatment of choice for patients who don’t respond well to NSAIDs and DMARDs.
Just like NSAIDs, however, corticosteroids come with side effects. Oral corticosteroids can cause high blood pressure, high blood sugar levels (which can contribute to diabetes), osteoporosis, skin thinning (which cause patients to bruise easily), and high risk of infections. Injectable corticosteroids, on the other hand, can cause high blood sugar levels along with skin thinning and loss of skin color on and near the injection site.9
Disease-modifying antirheumatic drugs (commonly called DMARDs) can slow down the progression of rheumatoid arthritis and prevent physical deformities caused by the destruction of bone and cartilage.
One of the most common DMARDs is methotrexate. It has been found to block certain enzymes that are involved in the immune system, although it’s not fully clear how it helps reduce the severity of rheumatoid arthritis.10 Methotrexate is usually available in 2.5 mg tablets, and the usual starting dose for adults is 7.5 to 10 mg (or 3 to 4 tablets) once a week. This can be increased to 25 mg per week depending on the patient’s condition.
Methotrexate comes with several side effects. The most common include vomiting, nausea, and liver abnormalities, although some patients also experience diarrhea, rashes, mouth sores, and hair loss.10 Patients who have existing liver problems may experience cirrhosis or scarring of the liver. Fortunately, these side effects can be reduced by taking folic acid or folinic acid supplements.11
Other types of DMARDs include leflunomide, hydroxycholorquine, sulfasalazine, azathioprine, and cyclophosphamide.12 They’re available as oral, injectable and infusion medications.
- BIOLOGIC AGENTS
Biologic response modifiers (usually called biologic agents) include abatacept (Orencia), adalimumab (Humira), etanercept (Enbrel), rituximab (Rituxan), infliximab (Remicade), and tocilizumab (Actemra). They are a type of DMARDs that target and suppress certain parts of the immune system to reduce the severity of rheumatoid arthritis. They are usually given to patients who show no signs of improvement after a three-month trial program with traditional DMARDs.13
Because biologic agents suppress the immune system, they usually increase patients’ risk for infection. Studies have shown that those who are taking biologic agents have a 30 percent higher chance of acquiring infections than those who are taking traditional DMARDs.14 This is particularly true for those who are prescribed standard-dose and high-dose biologic response modifiers.15
Aside from taking medications, patients with rheumatoid arthritis can go through physical and occupational therapies. In these therapies, they are taught how to do low-impact exercises that keep their joints flexible. They’re also taught how to go through their day-to-day activities without putting too much stress on their joints. 16
For patients with extreme joint and bone damage, physicians usually recommend surgeries to repair the damage. Timely surgical intervention can reduce pain, stop the progression of RA, and help patients regain normal function.17
Getting Your Prescribed Medications
If you’re suffering from rheumatoid arthritis, it’s important to find not just an experienced rheumatologist but also a specialty pharmacy that focuses on patients with RA. This way, you know that you’re getting high-quality medications and that you have the support of professional pharmacists who fully understand your health condition. Make sure to find a specialty pharmacy that’s available 24/7 to assist you in accessing your therapy, reminds you of your medication intake and refilling schedule, and helps you manage side effects.
- PubMed Health (2016) How do joints work? Available at: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072547/ (Accessed: 12 February 2017).
- Mayo Clinic (2016) Rheumatoid arthritis. Available at: http://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/home/ovc-20197388 (Accessed: 12 February 2017).
- Gramling, A. and O’Dell, J.R. (2012) ‘Initial management of rheumatoid arthritis’, Rheumatic Disease Clinics of North America, 38(2), pp. 311–325. doi: 10.1016/j.rdc.2012.05.003.
- WebMD (2015) NSAIDs for rheumatoid arthritis. Available at: http://www.webmd.com/rheumatoid-arthritis/guide/nsaids-rheumatoid-arthritis#1 (Accessed: 12 February 2017).
- Ramiro, S., Buchbinder, R., Landewé, R.B., van der Heijde, D. and Aletaha, D. (2012) ‘Pain management for inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and other spondyloarthritis) and gastrointestinal or liver comorbidity’, Cochrane Database of Systematic Reviews, . doi: 10.1002/14651858.cd008951.pub2.
- Perry, L.A., Mosler, C., Atkins, A. and Minehart, M. (2014) ‘Cardiovascular risk associated with NSAIDs and COX-2 inhibitors’, US Pharmacist, 39(3), pp. 35–38.
- Watson, S. (2016) Understanding RA Flares. Available at: http://www.arthritis.org/living-with-arthritis/pain-management/flares/ra-flare-up-severity.php (Accessed: 12 February 2017).
- Bingham, C. and Ruffing, V. (2016) Rheumatoid Arthritis Treatment. Available at: https://www.hopkinsarthritis.org/arthritis-info/rheumatoid-arthritis/ra-treatment/#cor (Accessed: 12 February 2017).
- Mayo Clinic (2015) Prednisone and other corticosteroids. Available at: http://www.mayoclinic.org/steroids/art-20045692?pg=2 (Accessed: 12 February 2017).
- American College of Rheumatology (2017) Methotrexate (Rheumatrex, Trexall, Otrexup, Rasuvo) – See more at: Http://www.Rheumatology.Org/I-Am-A/Patient-Caregiver/Treatments/Methotrexate-Rheumatrex-Trexall#sthash.OKPi0F6r.Dpuf. Available at: http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Treatments/Methotrexate-Rheumatrex-Trexall (Accessed: 12 February 2017).
- Swinden, M.V., Tanjong Ghogomu, E., Ortiz, Z., Katchamart, W., Rader, T., Bombardier, C., Wells, G.A. and Tugwell, P. (2013) ‘Folic acid and folinic acid for reducing side effects in patients receiving methotrexate for rheumatoid arthritis’, Cochrane Database of Systematic Reviews, . doi: 10.1002/14651858.cd000951.pub2.
- Arthritis Foundation (no date) Rheumatoid Arthritis Treatment. Available at: http://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/treatment.php (Accessed: 12 February 2017).
- Singh, J.A., Furst, D.E., Bharat, A., Curtis, J.R., Kavanaugh, A.F., Kremer, J.M., Moreland, L.W., O’Dell, J., Winthrop, K.L., Beukelman, T., Bridges, S.L., Chatham, W.W., Paulus, H.E., Suarez-almazor, M., Bombardier, C., Dougados, M., Khanna, D., King, C.M., Leong, A.L., Matteson, E.L., Schousboe, J.T., Moynihan, E., Kolba, K.S., Jain, A., Volkmann, E.R., Agrawal, H., Bae, S., Mudano, A.S., Patkar, N.M. and Saag, K.G. (2012) ‘2012 update of the 2008 American college of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis’, Arthritis Care & Research, 64(5), pp. 625–639. doi: 10.1002/acr.21641.
- Bauman, N. (2015) Largest analysis yet defines infection risk from RA Biologics. Available at: http://www.rheumatologynetwork.com/rheumatoid-arthritis/largest-analysis-yet-defines-infection-risk-ra-biologics-0 (Accessed: 12 February 2017).
- Singh, J.A., Cameron, C., Noorbaloochi, S., Cullis, T., Tucker, M., Christensen, R., Ghogomu, E.T., Coyle, D., Clifford, T., Tugwell, P. and Wells, G.A. (2015) ‘Risk of serious infection in biological treatment of patients with rheumatoid arthritis: A systematic review and meta-analysis’, The Lancet, 386(9990), pp. 258–265. doi: 10.1016/s0140-6736(14)61704-9.
- RheumatoidArthritis.org (2016) Rheumatoid Arthritis Therapy. Available at: https://www.rheumatoidarthritis.org/treatment/therapy/ (Accessed: 12 February 2017).
- Neumeister, M. and et al. (2017) Hand and Wrist Surgery in Rheumatoid Arthritis. Available at: http://emedicine.medscape.com/article/1287449-overview (Accessed: 12 February 2017).