Rheumatoid Arthritis: Finding the Right Medication for You

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Friday, 18 April 2008

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Rheumatoid Arthritis: Finding the Right Medication for You
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Pros and Cons of Medications Used to Treat Rheumatoid Arthritis continued...

There is a downside to many DMARDs: They can suppress the immune system, so there is greater susceptibility for infection while taking these drugs. It's important to watch for signs of infection like fever and chills.

DMARDs include:

Azathioprine (Imuran)
Cyclosporine (Neoral and Sandimmune)
Cyclophosphamide (Cytoxan and Neosar)
Gold salts (Ridaura)
Hydroxychloroquine (Plaquenil)
Leflunomide (Arava)
Methotrexate (Rheumatrex and Folex)
Minocycline (Dynacin and Minocin)
Penicillamine (Cuprimine and Depen)
Sulfasalazine (Azulfidine)

Biologics (Biological Response Modifiers)

This new class of drugs -- developed in the last few years -- offers great promise for treating rheumatoid arthritis. All have been FDA approved to treat RA, especially those people who have not benefited from DMARDs.

Biologics work by targeting specific components of the immune system called cytokines, which play a critical role in triggering inflammation in rheumatoid arthritis. Biologics can significantly slow progression of the disease within a few weeks.

In many cases, patients take a combination therapy -- a biologic and one (or more) standard DMARDs like methotrexate. This allows them to lower doses of an individual drug to be used, which may reduce the risk of side effects that can occur with higher doses.

However, the biologics can cause flare-ups of other chronic diseases that are in remission, particularly infections like tuberculosis.

The drugs are given by intravenous (vein) infusion or by injection, although pills will likely be available in the future.

Biologics include:

Abatacept (Orencia)
Adalimumab (Humira)
Anakinra (Kineret)
Etanercept (Enbrel)
Infliximab (Remicade)
Rituximab (Rituxan)

Questions for Your Doctor

All drugs have some side effects, and each individual reacts to a drug slightly differently than others. So it's important to work closely with your doctor. Together you can find the most effective drug for you, with the fewest side effects. Here are some questions to ask your doctor when developing your treatment plan.

Can my arthritis medicine increase my risk for other medical problems, such as heart disease, stroke, diabetes and other diseases?
Will any drugs cause stomach problems?
Will any drugs affect my blood sugar or weight?
What other side effects should I look for?
What should I do if I develop side effects?
What happens if I develop an infection while taking a DMARD?
Should I take the drug with food?
Will drinking alcohol affect the drug's effectiveness?
Are there side effects that could cause an emergency?

View Article Sources

SOURCES: American College of Rheumatology. Arthur Kavanaugh, MD, rheumatologist; professor of medicine, University of California at San Diego. VitaDocs Medical News: "New Rheumatoid Arthritis Drugs Work Well." Cleveland Clinic, "Arthritis Medicines Overview." VitaDocs Medical News: "Celebrex Linked to Heart Attacks." Cleveland Clinic, "Steroids to Treat Arthritis." Cleveland Clinic, "Disease-Modifying Medications" Cleveland Clinic, "Biologics." Medscape News: "FDA Approves Orencia." Singh, R. Current Opinion in Rheumatology, vol. 17, no. 3: pp. 274-279. A-Z Health Guide, "Rheumatoid Arthritis Medications." Arthritis Foundation Drug Guide.