I see a lot of questions and share posts about RA meds on the site, and rightfully so! The drugs we take are very potent and can be dangerous. Thought I would share my journey through DMARDS with you as well. Hopefully it can give some insight if your looking for info on the drugs. Lets talk about DMARDS on this post, and I will post on Pain Management Drugs later this month.
Wikipedia states Dmards are "Disease-modifying anti-rheumatic drugs (DMARDs) is a category of otherwise unrelated drugs defined by their use in rheumatoid arthritis to slow down disease progression. The term is often used in contrast to non-steroidal anti-inflammatory drug (which refers to agents that treat the inflammation but not the underlying cause) and steroids (which blunt the immune response but are insufficient to slow down the progression of the disease). But we know them better as MTX, Arava, Imuran, and the Bilogics, Humira, Orencia etc.
When I was first DXd with RA I was started on MTX and Pred, the pred helped the inflammation for sure, and I am still on 15mg a day. The MTX however spiked my liver numbers through the roof and I had to come off it very quickly. I was on 40 mg of Pred daily, which as I said helped immensely, but it came with a big price to pay. I became Diabetic, gained nearly 70 pounds and developed Addisons (Adrenal Insufficiency). I am stuck on 15 mg a day now and the doctors fear lowering that number as I could go into a adrenal crisis again.
I then started another DMARD, Plaquenil, and anti malarial drug also used to treat Lupus. Many people tolerate this drug very well. It had absolutely no effect on me, so I was only on it for a short time.
I then began Arava and tolerated that very well. Arava is know to affect your liver as well, but for some reason my numbers stay reasonable with it. I can tell you when I stopped taking it for a month this year to have a Nodule surgically removed I missed it! Once the proof was in that I could handle Arava I was started on Humira weekly.
Humira is a very handy drug as you can inject it at home on your schedule. However......WOW does it hurt to inject! I always told my wife it was like I was injecting Super Unleaded into myself! I had many tips come my way on how to lesson the pain. What I found that worked best for me was to ice the area I was about to inject until it became numb, meanwhile letting the syringe warm up to hear room temp. (Humira has to be refrigerated) This worked well for me for about six months. Then I started developing a large nasty purple rash in several spots on my body. Nothing could slow it down or stop it from itching. My Rheumy took me off the Humira and the rash vanished! (thank goodness! I still have scars from it!)
I started Rituxan after Humira. Rituxan is given by transfusion every three to six months. I was on every three months as I have severe RA. If you start Rituxan, bring a book! The infusions are five to six hours! Many people have side effect issues with this drug, mainly allergic reactions. I was blessed to not be affected by the side effects and at first felt better. By my sixth infusion or so, however, the magic had faded and I was no longer helped by the drug.
My next biologic was and still is, Orencia. Orencia is also given as an infusion, every four weeks. Orencia infusions take about an hour to receive. As with Rituxan they will ask you to take an anti-allergy drug prior to your infusion, as well as a pain med. They offer Benedryl and Tylenol at my docs office, I already take Zyrtec and Morphine Sulphate, so I am covered to start. They will flush you with saline and steroids and then start the Orencia. I have had no side effects at all with Orencia, Within a day or two I do get some relief from the swelling and pain, and MAN can I tell when its time to get my next infusion! No calendar needed for me! :)
If Orencia should fail I will start Cimzia. I have read many articles about having a "Plan B" with your doctor should one of your meds fail you. Not a bad idea!
Finally, please be aware that the drugs we take come with considerable risk for side effects. Many carry the FDA Black Box Warning. Its up to you and your doctor to decide if the benefits outweigh the risks. READ your RX bottle and follow the doctors orders to the letter! Some drugs are very dangerous to just stop or alter your dosing. Research the drugs as well!
I hope this may help those looking for some drug facts. I am also including a link to a great article about different treatment options for RA. You can find the article here. Later this month I will post about Narcotic Pain Meds. Hope you are all feeling better!
Also, please take a look at V's sharepost on the decision to take DMARDs.
Published On: June 06, 2011