How is Rheumatoid Arthritis Treated? Part IV of a Series
November 06, 2016
Information provided by the National Institute of Arthritis and Musculoskeletal and Skin Diseases
Most people who have rheumatoid arthritis take medications. Some medications (analgesics) are used only for pain relief; others, such as corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs), are used to reduce inflammation.* Still others, often called disease-modifying antirheumatic drugs (DMARDs), are used to try to slow the course of the disease. Common DMARDs include hydroxychloroquine, leflunomide, methotrexate, and sulfasalazine. Other DMARDs — called biologic response modifiers — may be used in people with more serious disease. These are genetically engineered medications that help reduce inflammation and structural damage to the joints by interrupting the cascade of events that drive inflammation. Currently, several biologic response modifiers are approved for rheumatoid arthritis, including abatacept, adalimumab, anakinra, certolizumab, etanercept, golimumab, infliximab, rituximab, tocilizumab, and tofacitinib. They work in one of several ways:
- Etanercept, golimumab, infliximab, adalimumab and certolizumab reduce inflammation by blocking tumor necrosis factor (TNF), a cytokine or immune system protein that triggers inflammation during normal immune responses.
- Anakinra works by blocking a cytokine called interleukin-1 (IL-1) that is seen in excess in people with rheumatoid arthritis.
- Rituximab stops the activation of a type of white blood cell called B cells. This reduces the overall activity of the immune system, which is overactive in people with rheumatoid arthritis.
- Abatacept blocks a particular chemical that triggers the overproduction of white blood cells called T cells that play a role in rheumatoid arthritis inflammation.
- Tocilizumab works by blocking a cytokine called interleukin 6 (IL-6) to reduce inflammation in people with rheumatoid arthritis.
- Tofacitinib, another DMARD from a new class of drugs call jak kinase (JAK) inhibitors, fights inflammation from inside the cell to reduce inflammation in people with rheumatoid arthritis.
For many years, doctors initially prescribed aspirin or other pain-relieving drugs for rheumatoid arthritis, and waited to prescribe more powerful drugs only if the disease worsened. In recent decades this approach to treatment has changed as studies have shown that early treatment with more powerful drugs — and the use of drug combinations instead of one medication alone — may be more effective in reducing or preventing joint damage. Someone with persistent rheumatoid arthritis symptoms should see a doctor familiar with the disease and its treatment to reduce the risk of damage.
The person’s general condition, the current and predicted severity of the illness, the length of time he or she will take the drug, and the drug’s effectiveness and potential side effects are important considerations in prescribing drugs for rheumatoid arthritis.
Many of the drugs that help reduce disease in rheumatoid arthritis do so by reducing the inflammation that can cause pain and joint damage. However, in some instances, inflammation is one mechanism the body normally uses to maintain health, such as to fight infection and possibly to stop tumors from growing. The magnitude of the risk from the treatment is hard to judge because infections and cancer can occur in people with rheumatoid arthritis who are not on treatment, and probably more commonly than in healthy individuals. Nevertheless, appropriate caution and vigilance are justified.
For more information about rheumatoid arthritis and other musculoskeletal health issues, visit www.niams.nih.gov. Join us next month for part 5 of the series on RA.
*Warning: NSAIDs can cause stomach irritation or, less often, they can affect kidney function. The longer a person uses NSAIDs, the more likely he or she is to have side effects, ranging from mild to serious. Many other drugs cannot be taken when a patient is being treated with NSAIDs because NSAIDs alter the way the body uses or eliminates these other drugs. Check with your health care provider or pharmacist before you take NSAIDs. Also, NSAIDs sometimes are associated with serious gastrointestinal problems, including ulcers, bleeding, and perforation of the stomach or intestine. People age 65 and older, as well as those with any history of ulcers or gastrointestinal bleeding, should use NSAIDs with caution.
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