10 Best Ways to Manage the Side Effects From RA Meds
You don’t necessarily need to wade through the pages of microscopic print tucked in your prescription box to know that your rheumatoid arthritis (RA) meds come with potential side effects. But as with any treatment for any condition, not everyone will experience adverse reactions. And for those who do, severity varies greatly. “In general, side effects usually aren’t bad enough to stop a patient from continuing a treatment that’s successful,” says Bruce Garner, M.D., a rheumatologist at NYU Langone Hospitals in New York City. Here, 10 ways to get a handle on the most common side effects you may face.
Log Your Symptoms and Side Effects
It’s a good idea to record any unfamiliar symptoms you experience when starting a new RA med. Whether you simply jot in a spiral notebook or log your info into a symptom tracker app, the important thing is that you’re helping to identify any cause and effect between your symptoms and their possible treatment triggers. And don’t keep your observations to yourself. Notice a change? Share it with your doctor. This way, says Dr. Garner, your physician can help mitigate any side effects.
Cool off Heartburn
Non-steroidal anti-inflammatory agents (NSAIDs) are the most widely used meds for temporary relief of pain and stiffness associated with RA. While their adverse gastrointestinal effects like heartburn are common and definitely not fun, they’re treatable, per a report in the journal Arthritis Research & Therapy. “Taking your meds at the end of a meal and with a lot of water often helps,” says J. Eugene Huffstutter, M.D., a rheumatologist in Hixson, Tennessee. You can also take NSAIDs with milk or OTC antacids to prevent upset. Still feeling the burn? Your physician can also prescribe a PPI (proton pump inhibitors) like Nexium or an H2 blocker like Pepcid to help reduce your stomach acid.
Nix These Triggers if You’re on NSAIDs
While it’s true that some RA meds can cause heartburn, it’s also true you can make it worse through your diet and lifestyle choices. “If you’re experiencing RA med-related reflux, consider avoiding a few foods and habits that are known triggers,” says Sonya Angelone, MS, RDN, a spokesperson for the Academy of Nutrition and Dietetics who specializes in the clinical management of inflammatory conditions. A few baddies: alcohol, coffee, chocolate, fried or fatty foods, spicy foods, eating too close to bedtime, and smoking.
Quell the Queasies
Methotrexate (a disease-modifying anti-rheumatic drug, or DMARD) is a rheumatologist favorite thanks to its ability to reduce pain, minimize swelling, and slow joint damage. Yet methotrexate also depletes your body of folate (folic acid), which can lead to nausea and vomiting, usually within 24 to 48 hours of your weekly dose. Many patients will take between 1 mg of folic acid daily (sometimes as much as 2-3 mg daily), not just the days before and after doses. Talk to your doctor about taking a high dose of folic acid 12 hours before methotrexate and 24 hours afterwards. Partnering folic acid with methotrexate yields a “significant reduction” in GI side effects, like nausea, concluded a 2013 Cochrane review. (Swapping oral methotrexate for the injectable version also sidesteps nausea.)
Get Your Flu Shot!
Only 37 percent of folks with RA received their influenza vaccination in the last two flu seasons, according to a 2018 report. Make yours a priority! “RA in and of itself weakens your immune system, making you more vulnerable to the flu. And if you’re taking steroids, DMARDs, biologics, or JAKs for your RA treatment, you’re even more susceptible to infections and need your flu shot,” says Dr. Huffstutter. (Just remember to get the actual shot, not the live FluMist spray, which is not recommended for immunocompromised individuals.)
Remember Your Other Vaccinations, too
“All RA patients need to be up to date on their shingles [herpes zoster] and pneumonia vaccinations,” says Dr. Garner. (According to the Arthritis Foundation, only about 50 percent of those with RA have had their pneumonia vaccine, and a mere 8 percent were vaccinated against shingles.) Not only are you significantly more likely to develop shingles (a virus related to chickenpox) and pneumonia than your non-RA counterparts, you may be on meds that further dampen your immune defenses against these conditions.
Combat Constipation With Exercise
About 66 percent of those with RA experience constipation, according to a 2011 study in the Journal of Nutrition. That’s mostly due to common RA meds like NSAIDs (ibuprofen, Celecoxib) and analgesics (acetaminophen, Codeine). Luckily, a stroll can help. “If you’re physically able, get more walking into your everyday,” says Angelone. Not only does exercise help to move food through your large intestine faster, aiding a swift exit, but regularly walking also helps keep your joints flexible. Win-win!
Rethink What You Eat and Drink
As long as you can tolerate it, drink more water to reduce RA-related constipation. It’ll help keep your stool soft and easy to pass. “Shoot to consume half your body weight in water daily,” says Angelone. Meaning: If you weigh 150 pounds, drink about 75 ounces of water a day. It’s also wise to gradually increase your intake of stool-softening fiber-rich foods like fruits, vegetables, and whole grains, while weeding out processed eats, which promote constipation. Bonus: According to the Arthritis Foundation, people who eat high-fiber diets also have lower C-reactive protein (CRP) levels in their blood. (CRP is a marker of inflammation that’s linked to RA.)
Tell Your Physician all the Meds You’re Taking
“That includes supplements, OTC drugs, and prescriptions,” says Dr. Garner. Turns out, the risk of adverse side effects from taking RA meds, including drug interactions, increases 13 percent with the use of two medications and 58 percent with the use of five, according to a 2011 report. For instance, Dr. Garner often sees patients who unwittingly double-dose on NSAIDS: “They’re taking a prescription NSAID and then another OTC medicine that contains an NSAID, too, but they don’t realize.” This can up your chances of experiencing ulcers, bleeding in the stomach, even kidney injury.
Don’t Freak out
“The commercials you see for RA meds have to list all of the possible side effects, but severe side effects occur quite infrequently,” says Dr. Garner. “I’d say 5 percent of my patients find the side effects of their RA treatment to be too much. Most will deal with a little nausea or diarrhea because they got their life back thanks to their treatment.” Still, some RA treatments are not meant for long-term use, in part because of the side effects. Taken over many months, high doses of corticosteroids, e.g., can cause things like cataracts and osteoporosis. “Have an open dialog with your doctor so you know what to expect,” says Dr. Garner.
Heartburn thanks to NSAID is common: Arthritis Research & Therapy. (2013). “Use of NSAIDs in treating patients with arthritis.” ncbi.nlm.nih.gov/pmc/articles/PMC3891482/
Folic acid combats methotrexate side effects: Cochrane Systematic Review. (2013). “Folic acid and folinic acid for reducing side effects in patients receiving methotrexate for rheumatoid arthritis.” cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000951.pub2/full
Too few RA patients get the flu shot: ACR/ARHP Annual Meeting. (2018). “Rates of Influenza Vaccination in a Cohort of Patients with Rheumatoid Arthritis and Psoriatic Arthritis.” acr.confex.com/acr/2018/meetingapp.cgi/Paper/75750
Not enough RA patients get other vaccines either: Arthritis Foundation. (2019) “RA & Vaccinations.” blog.arthritis.org/rheumatoid-arthritis/vaccinations-ra/
A lot of people with RA are constipated: Journal of Nutrition. (2011). “Supplemental treatment of rheumatoid arthritis with natural milk antibodies against enteromicrobes and their toxins: results of an open-labelled pilot study.” ncbi.nlm.nih.gov/pmc/articles/PMC3022554/
High fiber diets help those with RA in two ways: Arthritis Foundation. (2015). “More Fiber, Less Inflammation?” arthritis.org/living-with-arthritis/arthritis-diet/anti-inflammatory/fiber-inflammation.php
Drug interactions increase with the more RA meds you’re on: Brazilian Journal of Rheumatology. (2011). “Potential drug interactions in patients with rheumatoid arthritis.” scielo.br/scielo.php?script=sci_arttext&pid=S0482-50042011000100003&lng=en&nrm=iso&tlng=en