Normal joint
Joint affected by rheumatoid arthritis
What is rheumatoid arthritis?
Arthritis is a general term which describes inflammation in joints. Rheumatoid arthritis is a type of chronic (ongoing) arthritis that occurs in joints on both sides of the body (such as both hands, wrists or knees). This symmetry helps distinguish rheumatoid arthritis from other types of arthritis.
In addition to affecting the joints, rheumatoid arthritis may occasionally affect the skin, eyes, lungs, heart, blood, nerves or kidneys.
What are the goals of treating rheumatoid arthritis?
The most important short-term goal of treatment is to reduce joint inflammation. Joint pain and swelling improve once joint inflammation is reduced.
The long-term goal of treatment is to slow or stop joint damage, which can be seen on x-rays. Once joint inflammation stays under control, pain will be reduced.
Changing philosophy about drugs
In the past, many doctors did not believe that drugs for rheumatoid arthritis changed the eventual disability from the disease. Therefore, drugs with the least side effects were prescribed to decrease pain. Stronger drugs were avoided because of the doctors’ concerns about dangerous side effects.
Now, however, doctors know that early treatment can improve the long-term outcome for most patients. Newer drugs that have proven to be effective are being used soon after the patient is diagnosed. Combinations of drugs are proving to be more effective and in recent studies, just as safe as single drug treatment.
What drugs are used to treat rheumatoid arthritis?
The drugs used to treat rheumatoid arthritis can be divided into two groups:
- Drugs that decrease pain and local inflammation include aspirin and non-steroidal anti-inflammatory drugs or NSAIDS (such as ibuprofen or naproxen).
- Drugs that decrease pain and inflammation while decreasing the growth of abnormal synovial tissue (the tissue that lines the inside of the joint). These drugs include methotrexate and low doses of corticosteroids (such as prednisone or cortisone). In some people, these drugs also decrease joint destruction.
Other medications used to treat rheumatoid arthritis include: anti-malarial medications (such as hydroxychloroquine), gold, sulfasalazine, penicillamine, cyclophosphamide, cyclosporin and minocycline. Sometimes, more than one drug may be prescribed.
Newer biologic agents which block the effects of specific inflammatory factors (cytokines) are now available. Infliximab, etanercept and adalimumab block the cytokine anti-tumor necrosis alpha, and anakinra blocks the cytokine interleukin-1. These agents are somewhat more effective than previous medicines and can be combined with them, especially with methotrexate.
How well do the drugs work?
All the drugs used to treat rheumatoid arthritis have been tested in patients who have the disease and have been proven useful.
All of the NSAIDs are similarly effective, making it difficult for doctors to strongly recommend one over the other.
Methotrexate is among the drugs which are most effective in providing long-term benefits for people with rheumatoid arthritis.
Are the drugs dangerous?
The effectiveness and the risks of drugs are considered when your rheumatologist plans your treatment.
If a drug is very effective in treating an illness but causes a lot of side effects, it is not an ideal treatment. For example, high doses (15 to 20 mg or more per day) of corticosteroids can make people with rheumatoid arthritis feel dramatically better. However, high doses of corticosteroids may cause serious side effects when taken over many months or years.
In addition, NSAIDs are no more effective than full doses of uncoated aspirin, yet they are often prescribed because they are not as irritating to the stomach. Coated aspirin, such as Ecotrin, is much less irritating to the stomach than the same uncoated medicine.
What are some of the side effects of the drugs?
Since no drug is entirely safe, your doctor will talk to you about the possible benefits from the drugs as well as the risks and side effects. The occurrence of side effects depends on the dose, type of medication and length of treatment.
Some of the side effects of each type of drug used to treat rheumatoid arthritis are listed below.
Please note: the following side effects are the most common. All possible side effects are not included. Always contact your doctor if you have questions about your personal situation.
NSAIDs may cause the following side effects:
- Heartburn
- Stomach pain
- Ulcers
- Nausea and vomiting
- Diarrhea and/or constipation
- Fluid retention
- Worsened high blood pressure and/or kidney problems
Methotrexate can cause the following side effects:
- Upset stomach
- Mild hair loss
- Mouth sores
- Temporary decrease in red blood cells, white blood cells and platelets
- Liver damage
- Inflammation of the lungs (rare)
NOTE: Methotrexate may not be recommended for people who have kidney, lung or liver problems.
Corticosteroids (often called steroids) can cause the following side effects:
- Easy bruising
- Osteoporosis (bone weakening disease)
- Cataracts
- Weight gain
- Increased risk of infections
- Diabetes
- High blood pressure
NOTE: Many of the side effects (as well as the benefits) of steroids are directly related to the dose that is prescribed. Certain people with rheumatoid arthritis can take daily low doses of cortisone with minimal risk and great benefits.
The newer biologic agents can cause the following side effects:
- Increased likelihood and worsening of certain infections, especially tuberculosis
- Neurologic symptoms like multiple sclerosis
- Higher likelihood of lymphoma (cancer of the lymph system)
How will my doctor choose drugs that are right for me?
Your doctor will work with you to develop a treatment program. The drugs prescribed will match the seriousness of your condition.
Your doctor will combine the results of your medical history, physical exam, X-rays and blood tests to create your treatment program. Your doctor will also consider your age, sex, physical activity, other medications you are taking and the presence of other medical conditions.
It is important to meet with your physician regularly so he or she can closely monitor you to detect the development of any side effects and monitor your treatment if necessary. Your doctor may periodically order blood tests or other tests to determine the effectiveness of your treatment and the presence of any side effects.
