Rheumatoid arthritis

RA; Arthritis - rheumatoid

RA usually requires lifelong treatment, including medications, physical therapy, exercise, education, and possibly surgery. Early, aggressive treatment for RA can delay joint destruction.

MEDICATIONS

Disease modifying antirheumatic drugs (DMARDs): These drugs are the current standard of care for RA, in addition to rest, strengthening exercises, and anti-inflammatory drugs. Methotrexate (Rheumatrex) is the most commonly used DMARD for rheumatoid arthritis. Leflunomide (Arava) may be substituted for methotrexate. These drugs are associated with toxic side effects, so you will need frequent blood tests when taking them.

Anti-inflammatory medications: These include aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. Although NSAIDs work well, long-term use can cause stomach problems, such as ulcers and bleeding, and possible heart problems. NSAID packaging now carries a warning label to alert users of an increased risk for cardiovascular events (such as heart attack or stroke) and gastrointestinal bleeding.

Antimalarial medications: This group of medicines includes hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine), and is usually used in combination with methotrexate. It may be weeks or months before you see any benefit from these medications.

Corticosteroids: These medications work very well to reduce joint swelling and inflammation. Because of potential long-term side effects, however, corticosteroids should be taken only for a short time and in low doses when possible.

Cyclooxygenase-2 (COX-2) inhibitors: These drugs block an inflammation-promoting enzyme called COX-2. This class of drugs was initially believed to work as well as traditional NSAIDs, but with fewer stomach problems. However, numerous reports of heart attacks and stroke have prompted the FDA to re-evaluate the risks and benefits of the COX-2s. Celecoxib (Celebrex) is still available, but labeled with strong warnings and a recommendation that it be prescribed at the lowest possible dose for the shortest possible duration. Talk to your doctor about whether COX-2s are right for you.