Diseases > Rheumatoid Arthritis | RA > Treatment for Rheumatoid Arthritis
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Treatments for Rheumatoid Arthritis
If you’ve read our section “About Rheumatoid Arthritis“, you now know that it is important to get treatment early, see a rheumatologist, and get the fire put out! The next question is what medications can I use?
Medications for RA fall under two broad groups:
- Medications which control the disease and prevent long-term damage
- Medications which control symptoms
Medications that prevent long-term damage
There are two broad groups of medications which fall into this category. Medications that prevent long-term damage also work to control the symptoms of RA. You’re getting a 2 for 1!
- Disease Modifying Anti-Rheumatic Drugs (DMARDs)
DMARDs are medications that control symptoms and prevent long-term damage. Examples of DMARDs include methotrexate, sulfasalazine, hydroxychloroquine (plaquenil), leflunomide (arava), gold (myochrisine), and azathioprine (imuran). DMARDs have been around for a long-time and can work very well to control disease. We know that using two or three DMARDs together (combination therapy) works better than using a single DMARD alone. Common combinations include the famous triple therapy which consists of methotrexate, sulfasalazine, and hydroxychloroquine. Most DMARDs take some time to work (about 6-12 weeks) so you might not feel any effect when you first start. It’s important to keep at it to get that fire put out.
Biologics are a newer class of medications which have been around for the past 10+ years. Biologics were specifically designed to treat rheumatoid arthritis and they work really well. Biologic medicines are often given in combination with DMARDs because every study shows that they always work better when combined with a DMARD like methotrexate. Like DMARDs, biologics control symptoms and prevent long-term damage! Examples of biologic medications include Humira, Remicade, Enbrel, Cimzia, Simponi, Rituxan, Orencia, and Acemtra! Yes, there are now 8 biologics available and more on the way.
Medications that control symptoms
There are three broad groups of medications which fall into this category:
It is argued that medications like prednisone may also prevent long-term damage. Prednisone is a very effective medication to control the symptoms of RA. In the short-term, prednisone works very well to control symptoms, however, when used for long periods of time it can have side effects. You need to discuss the risks and benefits of using prednisone with your rheumatologist.
NSAIDs are medications which only control the symptoms. Examples of NSAIDs include celebrex, naproxen, arthrotec, mobicox etc.
Analgesic medications only control pain. Their use is quite limited in RA. Essentially we use these medications when someone has damaged a joint and is in pain because of damage. When damage occurs, controlling the disease doesn’t help as much as the damage is already done.
Our Treatment Philosophy
You want to keep looking good for a long time!
It’s important to keep your joints looking good. Think of it like this – imagine you want to keep your face looking good for a long time. Putting on lipstick will help from day to day but to keep the wrinkles away you’re probably going to need a facelift at some point. The same is true with rheumatoid arthritis. You need to use the DMARDs and biologic medications as they are like getting a face lift. They’ll protect your joints over the long-run and keep them looking good for a long time. For day to day pain and discomfort then NSAIDs, prednisone, and analgesics can be used. They’re like lipstick – somedays you need them and somedays you feel pretty good and don’t. Sorry guys, this analogy doesn’t work as well for you!
If you absolutley need to put on the lipstick every day (take NSAIDs, steroids etc) then you have to question just how well controlled your RA is. You’ll need to discuss this with your rheumatologist because not all pain is due to RA!
Take Home Messages
- Treat RA early
- Use combinations of DMARDs and biologics to control symptoms and prevent long-term damage
- Use NSAIDs and occasional prednisone to control flares
- See your rheumatologist regularly
- Get your blood tested regularly
- Stay hopeful