DMARDs for Rheumatoid Arthritis

All biologic response modifiers must be injected. Because of their cost , biologics are often reserved for people who have not completely responded to DMARDs and for those who cannot tolerate DMARDs in doses large enough to control inflammation. Unlike DMARDs, which can take a month or more to begin working, biologics work rapidly, within two weeks for some medications and within four to six weeks for others. Abatacept is usually recommended only for people with moderate or severe rheumatoid arthritis that is not controlled with methotrexate and an anti-TNF agent. Abatacept interferes with the activation of T cells. Anakinra cannot be used at the same time as anti-TNF agents due to the risk of infection. It is occasionally recommended for selected individuals who do not respond to anti-TNF agents. Anakinra is significantly less potent than TNF inhibitors in most people with rheumatoid arthritis. Biologics that bind tumor necrosis factor , called anti-TNF treatments, include Etanercept , adalimumab , and infliximab.

Glucocorticoids for Rheumatoid Arthritis

Glucocorticoids quickly improve symptoms of rheumatoid arthritis such as pain and stiffness, and also decrease joint swelling and tenderness. Glucocorticoids may be taken by mouth, injected into a vein, or injected directly into a joint. Drugs in this class include prednisone and prednisolone. Steroids Glucocorticoids, also called steroids have strong anti-inflammatory effects. TNF-inhibitors have been associated with a further increase in the risk of lymphoma in some studies; more research is needed to define this risk. TNF-inhibitors are not recommended for people who have lymphoma or have been treated for lymphoma in the past; people with rheumatoid arthritis, especially those with severe disease, have an increased risk of lymphoma regardless of what treatment is used. People who have evidence of prior TB infection should be treated because there is an increased risk of developing active TB while receiving anti-TNF therapy. Testing for tuberculosis is necessary before starting anti-TNF therapy. Side effects Biologic response modifiers interfere with the immune system's ability to fight infection and should not be used in people with serious infections. Remicade, Orencia and Rituxan must be injected into a vein, which is typically done in a doctor's office or clinic; this takes between one and three hours to complete.

Methotrexate for Rheumatoid Arthritis

Rest is often helpful during flares; hospitalization is rarely necessary. Alternately, flares can be controlled by steroids that are given by injection. In people who are already taking methotrexate or oral steroids, flares can often be controlled by increasing the doses of these drugs. Treatment of flares Flares are temporary exacerbations of rheumatoid arthritis that can occur in addition to the ongoing inflammation. However, people with a badly damaged joint who cannot undergo joint replacement surgery may benefit from use of a long acting narcotic under the supervision of a rheumatologist or pain specialist. Use of narcotic analgesics such as such as codeine, oxycodone, and hydrocodone is generally discouraged because of the long term nature of rheumatoid arthritis and the risk of dependence and addiction.

Treatment of Rheumatoid Arthritis

Oral glucocorticoids are not frequently recommended for people with mild rheumatoid arthritis. These medications are discussed in more detail in a separate topic review. If one or more joints remain swollen or tender after a few weeks of treatment with an NSAID, one or more DMARDs may be recommended, including methotrexate, hydroxychloroquine, or sulfasalazine. This combination is continued only until inflammation has subsided. Mild rheumatoid arthritis is usually treated initially with nonpharmacologic therapies and an NSAID. Severity of rheumatoid arthritis The severity of rheumatoid arthritis is based upon the severity of inflammation. Activity of rheumatoid arthritis The activity of rheumatoid arthritis refers to the presence of joint swelling. The type and sequence of drugs used for rheumatoid arthritis treatment depends upon three factors: the activity, severity, and stage of rheumatoid arthritis.