Rheumatoid Arthritis Treatment Options

Nonsteroidal anti-inflammatory drugs (NSAIDs) treat the symptoms of pain and inflammation, but do not affect RA, the cause of the symptoms. Some NSAIDs are available over-the-counter, including ibuprofen and naproxen. Stronger versions of these, plus other kinds of NSAIDs, are available by prescription. This type of drug is notoriously hard on the stomach, potentially causing gastric ulcers, and it’s also important to keep an eye on your blood pressure and heart health while taking them.

Steroids, also known as corticosteroids, are similar to cortisol, a hormone naturally produced in your adrenal gland. They reduce inflammation and suppress the immune system, although not to the same extent as immunosuppressant drugs used for RA. Common side effects include increased appetite, weight gain, and bone softening. You may also experience mood swings. Some rheumatologists see them as a valuable tool to treat RA, either as tablets or joint injections, while others won’t use them.

Disease modifying antirheumatic drugs (DMARDs) do exactly what the name suggests: They modify your RA to slow down its progression and hopefully help you go into remission. Common DMARDs include methotrexate, hydroxychloroquine (Plaquenil), and leflunomide (Arava). Common side effects may include stomach upset and fatigue, although this may decrease as your body gets used to the medication. Some DMARDs also require regular bloodwork to watch for potential effect on internal organs.

Biologics are the newest class of medications to treat RA. They target specific inflammatory proteins. Biologics are immunosuppressant drugs, so when you take them you will be more susceptible to catching colds and flus, and infection — particularly sinus infections. This is usually manageable with basic precautions. Other common side effects include fatigue and queasiness after taking your biologic. Biologics can be quite expensive, but financial assistance programs are available.

Choosing a biologic can depend on a number of different factors. Some are administered by self-injections in your home, others by infusion in a clinic setting. There is also one biologic available in tablet form. Different biologics target different inflammatory proteins, such as Tumor Necrosis Factor (TNF), interleukin-1, interleukin-6, and others. You may respond to one biologic and not to another, depending on which inflammatory proteins are involved in your case of RA.

With the advance of new and better treatments, particularly the biologics, more people with RA than ever before now experience remission or low disease activity. In fact, RA is becoming increasingly an invisible illness. However, not all respond to the medications on the market, so 30 to 50 percent of individuals who have RA may still have active disease. More biologics are in development and biosimilars, a sort of generic biologic, are also becoming an option for treatment.

Because better treatments are now available, the approach to RA treatment has changed. In the past, treatment would gradually and slowly increase from NSAIDs to milder DMARDs and more (called “go low and go slow”). We now know that treating early and aggressively is the best option to achieve remission and rheumatologists currently use the treat-to-target approach that is also used to treat, for instance, diabetes. This can include adjusting medications every three months until remission occurs.

Many people with RA worry about taking medications, seeking instead to explore natural remedies. At this time, there is no scientific evidence that herbal medication and other alternative regimens can control RA, although some can help symptoms. Keep in mind that herbal drugs are a form of medication, with side effects and interactions just like any other drug. If you want to explore this area, please consider consulting a specialist, such as a naturopathic doctor.

There is no single answer to treat everyone’s RA. People react differently to medications. Insurance coverage and availability of financial assistance can also affect your ability to take certain drugs. It can take some time to find the medication or combination of medications that can control your disease — the right “key to your lock,” if you will. Finding a good rheumatologist and working as a team with them is key to discovering what works best for you.