Rheumatoid Arthritis medications & treatments
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Rheumatoid arthritis (RA) is a chronic autoimmune and inflammatory disorder that mainly attacks your joints. It is the most common type of autoimmune arthritis. It is estimated that RA affects around 1.5 million Americans, with 75% of them being women. Rheumatoid arthritis often begins in women between the ages of 30 to 60 and men after the age of 45.
What is rheumatoid arthritis?
Rheumatoid arthritis (RA) is a chronic autoimmune disease, which means your immune system mistakenly attacks healthy cells, causing inflammation (swelling) in the lining of your joints (synovium). This inflammation causes damage to the joint tissue which can lead to bone erosion, chronic pain, and joint deformity. This joint damage usually cannot be reversed once it occurs.
RA occurs in the joints on both sides of your body. It most commonly affects small joints in the hands, knees, and ankles but can also cause damage to other parts of the body such as your eyes, heart, and lungs.
Rheumatoid arthritis causes
Researchers are not sure what exactly causes RA but some risk factors for developing this condition include:
- Age. Although symptoms can begin at any age, the onset of RA is highest among adults between the ages of 40 to 60.
- Sex. Women are 3 times more likely to develop RA than men.
- Genetics. Researchers think some people with RA may have certain genes that are activated by a trigger in the environment, such as smoking or a virus.
- Obesity. The more overweight you are, the higher your risk of developing RA becomes.
- Smoking. Studies show that smoking cigarettes significantly increases your risk of RA. It can also worsen your symptoms if you get the disease.
- Environmental factors. Exposure to toxins such as secondhand smoke can put you at an increased risk of developing rheumatoid arthritis.
How is rheumatoid arthritis diagnosed?
To properly diagnose rheumatoid arthritis, your healthcare provider may refer you to a doctor who specializes in treating arthritis called a rheumatologist. They will look at your symptoms, review your medical history, perform a physical exam, and run some tests.
Rheumatoid arthritis symptoms
Symptoms of RA can develop gradually over a few weeks or suddenly over a few days, and include:
- Joint pain, swelling, and stiffness in more than 1 joint
- Morning stiffness that lasts for more than 30 minutes
- The same joints on both sides of the body are affected
- Weight loss
If your doctor suspects you have RA based on your physical exam and symptoms, they will order additional testing to rule out other possible causes and confirm your diagnosis. These tests can include:
These blood tests will look for inflammation and certain antibodies that are typically present in RA. Tests include:
- Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels are used to check for inflammation. This can’t confirm a diagnosis as many diseases cause inflammation.
- Rheumatoid factor (RF) is found in about half of all people with RA when the condition first starts.
- Anti-CCP antibodies are found in 60 to 70% of people with RA.
- A full blood count can be used to rule out other conditions as well as check for anemia.
Your doctor may use x-rays, MRIs, and ultrasounds to check for inflammation and damage to your joints. These can be used to help diagnose rheumatoid arthritis and to check if the disease is progressing or if your treatment is working.
What are some rheumatoid arthritis treatment options?
The goals of your RA treatment will be to:
- Reduce joint stiffness, pain, and swelling by reducing inflammation
- Slow the disease progression
- Prevent joint and organ damage
- Improve your quality of life
Early treatment is the key to successfully managing your condition and can include medications, physical therapy, lifestyle changes, and sometimes surgery.
- Disease-modifying antirheumatic drugs (DMARDs). These medications help relieve symptoms while slowing down the disease progression. They are often combined with an NSAID or a corticosteroid to help reduce inflammation. These medications include Trexall (methotrexate), Plaquenil (hydroxychloroquine), and Azulfidine (sulfasalazine).
- Janus kinase (JAK) inhibitors. These medications are another type of DMARD and are often used when methotrexate alone is not successfully treating your condition. They include Xeljanz (tofacitinib) and Olumiant (baracitinib).
- Biologics. If disease activity remains moderate to high despite the use of DMARD therapy, your doctor may try a biological agent. These injectable medications target chemicals in your blood that cause your immune system to attack your joints. They include Enbrel (etanercept), Remicade (infliximab), Humira (adalimumab), and Simponi (golimumab).
- Non-steroidal anti-inflammatory drugs (NSAIDs). Medications such as Advil/Motrin (ibuprofen) and Aleve (naproxen) are usually combined with other medications to help relieve inflammation and pain.
- Corticosteroids. These medications, including Deltasone (prednisone) and Medrol (methylprednisolone), are also usually combined with other treatments to help with inflammation and pain.
Physical and Occupational Therapy
A physical therapist can help you develop an exercise plan to improve your muscle strength and make your joints more flexible. They also can show you how to use heat or ice packs for pain relief.
An occupational therapist can help teach you to protect your joints while you’re at home or work. They may recommend things such as a splint to help support your joints as well as other devices that can help you perform everyday tasks.
Severe cases of RA that don’t respond to medications may require surgery. This can include joint replacement for your affected joints (hip and knee replacements are most common) or surgery to correct a deformity.
What is the best medication for rheumatoid arthritis?
The best medication for the treatment of rheumatoid arthritis will depend on the individual’s specific medical rheumatoid arthritis, medical history, medications that the individual is already taking that may potentially interact with rheumatoid arthritis medications and the individual’s potential response to the treatment. It is advisable to always speak with your healthcare provider about the best medication for you. The table below includes a list of the most prescribed or over-the-counter rheumatoid arthritis medications approved by the Food and Drug Administration (FDA).
Best medications for rheumatoid arthritis
|Drug name||Drug class||Administration route||Standard dosage||Common side effects
|Humira (adalimumab)||Tumor necrosis factor (TNF) inhibitor||Injection||160mg under the skin, on day 1, then 80mg 2 weeks later, then 40mg every 2 weeks as maintenance.||Injection site reactions, upper respiratory infection, headache, rash
|Remicade (infliximab)||TNF inhibitor||Injection||5mg/kg IV infusion at 0, 2, and 6 weeks, then every 8 weeks thereafter.||Infection, nausea, abdominal pain, headache, infusion site reaction
|Simponi (golimumab)||TNF inhibitor||Injection||200mg under the skin to start, 100mg at week 2, then 100mg every 4 weeks thereafter.||Upper respiratory tract infection, injection site reactions, viral infections
|Cimzia (certolizumab pegol)||TNF inhibitor||Injection||400mg under the skin every 4 weeks.||Rash, upper respiratory infection, bladder infection
|Enbrel (etanercept)||TNF inhibitor||Injection||50mg under the skin once weekly.||Infection, injection site reactions, diarrhea, rash
|Orencia (abatacept)||Immunomodulator||Injection||125mg under the skin once weekly.||Headache, infection, nausea, common cold, dizziness
|Kineret (anakinra)||Immunomodulator||Injection||100mg under the skin once daily.||Injection site reaction, headache, nausea, diarrhea
|Entyvio (vedolizumab)||Integrin blocker||Injection||300mg IV infusion at 0, 2, and 6 weeks, then every 8 weeks thereafter.||Common cold, headache, joint pain
|Stelara (ustekinumab)||Interleukin inhibitor||Injection||Initial weight-based IV infusion, then 90mg under the skin every 8 weeks thereafter.||Upper respiratory tract infection, injection site reaction, headache
|Actemra (tocilizumab)||Monoclonal antibody||Injection||Weight-based dose is given every 4 weeks as an IV infusion or weekly injection under the skin.||Injection site reaction, common cold, headache, upper respiratory infection, high blood pressure
|Rituxan (rituximab)||Monoclonal antibody||Injection||1000mg given via IV infusion, repeat after 2 weeks, then repeat the course every 24 weeks.||Injection site reactions, swelling, nausea, diarrhea, headache
|Kevzara (sarilumab)||Interleukin inhibitor||Injection||200mg under the skin every 2 weeks.||Injection site reactions, infection, decreased platelets
|Imuran (azathioprine)||Immunosuppressant||Oral||1.5mg/kg to 3mg/kg once daily.||Bone marrow suppression, abdominal pain
|Arava (leflunomide)||Immunosuppressant||Oral||100mg once daily for 3 days, then 10mg to 20mg once daily thereafter.||Diarrhea, respiratory infections, hair loss, high blood pressure, nausea
|Azulfidine (sulfasalazine)||5-aminosalicylate||Oral||2g to 4g per day in divided doses.||Nausea, vomiting, headache, upset stomach
|Xeljanz (tofacitinib)||JAK inhibitor||Oral||10mg twice daily for at least 8 weeks, then 5mg to 10mg twice daily thereafter.||Common cold, elevated cholesterol levels, headache
|OlumiantOlumiant (baricitinib)||JAK inhibitor||Oral||2mg once daily.||Upper respiratory infection, nausea, increased platelets, herpes infection
|Rinvoq (upadacitinib)||JAK inhibitor||Oral||15mg once daily.||Upper respiratory infection, nausea, cough, fever, low white blood cell count
|Deltasone (prednisone)||Steroid||Oral||Up to 60mg daily. Usually tapered off over a couple of weeks.||Increased heart rate, mood changes, increased appetite, fluid retention, weight gain
|Celebrex (celecoxib)||COX-2 inhibitor||Oral||100mg to 200mg every 12 hours.||Headache, high blood pressure, fever, upset stomach, cough
Your healthcare provider will determine the right dosage based on your response to the treatment, medical rheumatoid arthritis, weight, and age. Other possible side effects may exist; this is not a complete list.
What are the most common side effects of rheumatoid arthritis medications?
As with all medicines, those used to treat rheumatoid arthritis will have some side effects, depending on the class you are taking:
- DMARDs commonly cause injection site reactions, infections, headaches, rash, nausea, and stomach pain.
- JAK inhibitors can cause viral infections, upper respiratory infections, nausea, cough, and fever.
- Biologics’ most common side effects include nausea, vomiting, headache, stomach pain, and rash.
- NSAIDs commonly cause upset stomach, headache, increased blood pressure, and increased risk of bleeding.
- Corticosteroids or glucocorticoids can cause weight gain, increased appetite, mood changes, acne, and increased heart rate.
What are some home remedies for rheumatoid arthritis?
While medications are the main focus of the treatment of RA, there are self-care measures you can take to help relieve some symptoms.
Rheumatoid arthritis management
Try some of these tips to help you relieve some RA symptoms such as joint and muscle pain, and inflammation, and improve your overall ability to do daily activities:
- Be active. Regular exercise can help improve muscle strength, improve joint mobility, and delay joint damage. Experts recommend 150 minutes of moderate physical activity per week to see these benefits.
- Rest your joints when necessary. While staying physically active is important, rest can be equally important in preventing injuries, especially when you are experiencing a flare-up.
- Use hot or cold treatments. Use heating pads or warm baths to soothe stiff joints and muscles and ice packs or cold compresses to relieve swollen joints and inflammation.
- Maintain a healthy weight. Research has shown that weight loss in overweight adults with RA can help reduce pain and disability.
- Stop smoking. Studies have shown that smoking cigarettes can worsen your RA symptoms.
Frequently asked questions about rheumatoid arthritis
What’s the difference between osteoarthritis and rheumatoid arthritis?
While they both cause pain and stiffness in your joints, osteoarthritis is due to a breakdown of your cartilage over time due to inflammation and injury and RA happens when your immune system attacks and damages the lining of your joints.
What are some complications of RA?
RA can put you at a higher risk of serious complications, especially if it’s not effectively treated. This includes:
- Pleurisy (inflammation in your lungs)
- Pericarditis (inflammation in the tissue around your heart)
- Scleritis (eye redness, pain) or Sjögren’s syndrome (dry eyes)
- Vasculitis (inflammation of your blood vessels)
- Cardiovascular disease, which can lead to a heart attack or stroke
- Rheumatoid nodules
Can rheumatoid arthritis be cured?
RA is a lifelong condition with no cure. You will typically have periods where you don’t have any symptoms (remission) that occur during flare-ups. Any damage that occurs to your joints is permanent.
Related resources for rheumatoid arthritis
The content on this website is intended for information purposes only. It does not constitute medical advice. The information on this website should not be relied upon and is not a substitute for professional medical advice. You should always speak to your doctor regarding the risks and benefits of any treatment.