There are many medications for the management of the symptoms and treatment of rheumatoid arthritis, an inflammatory condition characterized by non-tender nodules, swelling, redness and pain on the joints, as well as limited range and mobility on the affected body parts.
The common medications used in the treatment of rheumatoid arthritis are painkillers steroids, NSAIDs, DMARDs and biologic agents. DMARDs are particularly special because they do not simply manage the symptoms. They reduce the destructive effects of the condition on the joints as well.
Disease Modifying Anti-rheumatic Drugs or DMARDs
DMARDs are specifically designed to reduce and delay the joint damage that is caused by the condition. DMARDs are part of an overall treatment plan for rheumatoid arthritis. Rheumatrex is the most commonly used DMARD because it has been found to be the most effective. The biggest advantage that it has is that it can be taken for long periods and is even safe on children. However, side effects in some cases may include upset stomach, liver and bone marrow toxicity and birth defects. Shortness of breath has also been observed in patients taking this drug. Those taking methotrexate are advised to undergo regular bloodwork to make sure that the bone marrow is functioning and to determine problems with the liver.
The choice of what DMARD to use depends on a number of factors, including the stage and severity of the condition, the balance between the possible side effect and benefits, and patient preference. The patient is often informed of the many side effects that he or she may potentially encounter before he or she can give consent to take any of the drugs.
How DMARDs are given
In some cases, one DMARD is used for one patient. However the more common practice is giving patients a combination of DMARDs right after diagnosis. A patient who does not respond to one DMARD may be given a combination of two medications, with methotrexate as one of them.
Methotrexate
This drug was originally used as a treatment for cancer. When used in much lower doses, the drug is effective at lowering the intensity of the inflammation and decrease bone damage. Methotrexate is often taken once a week as a pill, liquid or as an injection. It is often started at a low dose which is then gradually increased. Common side effects include upset stomach and sore mouth. Like other DMARDs, it can interfere with the production of blood cells. Low blood cell counts make the person more predisposed to infections. Patients taking the drug are often advised to take folic acid 1 mg daily or folic acid 5 mg weekly to reduce the risk of side effects.
Methotrexate also poses risks to pregnant women. It can cause miscarriages and serious birth defects. Those who take the drug must use a reliable form of birth control in order to avoid pregnancy. Men on this drug should discontinue the medication and wait three months before they can attempt to conceive with their partners.
Sulfasalazine
This is another DMARD that is used in the treatment of arthritis with ankylosing spondylitis and ulcerative colitis. Although it is not clear how this medication works, the drug is often given in combination with other DMARDs especially if it does not respond to other medications. It is taken twice a day in pill form and started at a low dose, at about 500 mg. Side effects include nausea and vomiting, abnormalities in the blood count, sensitivity to sunlight, skin rashes, headaches. Patients taking this drug are required to undergo blood tests every two weeks to check on the condition of the blood. The risks on pregnant women is low, so they may be allowed to take the drug even when pregnant. Patients taking the drug must also drink plenty of fluids and to avoid taking the drug on an empty stomach.
Hydroxychloroquine
This was originally developed as a treatment for malaria but was later found helpful for symptoms of arthritis. It is used in combination with other DMARDs and can also be used for patients with systemic lupus erythematosus. This drug is often taken in pill form once a day. Long term use of this drug can damage the retina, however. It is therefore important to have an eye examination before starting the treatment. Eye exams should also be done every 6 to 12 months thereafter.
Leflunomide
This is another DMARD that inhibits the production of inflammatory cells in order to reduce inflammation. It is often given with metothrexate. Side effects include rash, temporary hair loss, liver damage, nausea and vomiting, weight loss, diarrhea and abdominal pain. This is not considered safe for use in pregnant women.
Cyclosporine
Originally used in heart transplant patients, cyclosporine works in patients by inhibiting the T-lymphocytes that contribute to the inflammation. Side effects include high blood pressure, heartburn, swelling, kidney damage, hirsutism, diarrhea and nausea. Patients taking this drug must undergo regular blood pressure monitoring as well as monitoring of liver and kidney functions.
Azathioprine
Initially used in the treatment of cancer, this drug is prescribed when other medications do not work on RA patients. Side effects include nausea, vomiting, decreased appetite and liver function abnormalities.