Imagine a terrible swelling, pain, and stiffness in your hand joints–so you can barely tie your shoes. Imagine “loosening up” for hours every morning just to get limber enough to move around the house.
Rheumatoid arthritis sufferers have to live with this sort of thing every day.
The cause is your own immune system, which attacks your joints and organs. Over the years it can permanently deform your joints.
The disease can also damage you in other ways before you even notice distortions in the appearance of your hands and other joints. The severe pain and swelling it causes may keep you from working or even preparing meals. The symptoms can be bad enough to force a person to leave work and go on disability.
In the last decade, researchers have made tremendous progress in understanding what causes rheumatoid arthritis and what we can do to effectively treat it.
Reducing Hurt and Harm
Treatments for rheumatoid arthritis are intended to reduce the pain and other symptoms it causes and to slow down joint destruction.
Treating the pain and inflammation helps sufferers feel better and improves their ability to use the affected joints. Doctors use common over-the-counter anti-inflammatory drugs like ibuprofen and naproxen and newer medications called COX-2 inhibitors that are just as effective but that have fewer side effects.
These drugs can help reduce your pain, but they don’t slow down the destruction of your joints. In other words, you may feel better at the same time that your joints are being continuously damaged by the disease.
The good news is that in recent years, researchers have also made great strides in learning how to treat the joint damage that the disease causes. Doctors now use drugs called DMARDs (which stands for disease-modifying antirheumatic drugs). These medications slow the pace of joint destruction and improve sufferers’ ability to function in daily life.
The problem with some of the older DMARDs is that they caused serious side effects, so people stopped taking them. Today, however, there are readily available DMARDs that are quite effective, easier to take, and have fewer side effects.
DMARDs to the Rescue
Methotrexate is one of the most commonly used DMARDs. One of its major advantages is that you take it only once a week. More importantly, it’s very effective: Studies have shown that taking methotrexate can help people with rheumatoid arthritis function better in their daily routine. Their quality of life often improves too. Many doctors today use this medication as their first line of attack against the disease. Although its side effects are relatively mild, your doctor will need to take blood samples every so often to make sure it doesn’t cause liver or kidney damage.
A newer DMARD is called leflunomide (brand name Arava). It seems to work just as well as methotrexate at reducing symptoms and improving quality of life. In fact, it seems to work even for patients who methotrexate does not help. Diarrhea and itchy skin are the most common side effects. As with methotrexate, patients need to have their blood checked regularly.
Research has suggested that the combination of methotrexate and leflunomide may work better than either alone, but some doctors worry that the combination may also increase the number of side effects.
If you can’t get relief from conventional therapy, there are also two other medications, infliximab (Remicade) and etanercept (Enbrel), that are often tried. Neither is available in pill form, so they’re harder to take: Etanercept is self-administered as a shot twice a week. Infliximab is given every other week intravenously. As you might imagine, both are quite expensive, but they do work well in people with severe rheumatoid arthritis.
What medications should you begin with if you’ve just been diagnosed as having rheumatoid arthritis? Part of the answer to this question is simple, but the other part is more controversial.
To start with, you should be on a medication to reduce the pain and symptoms. This can be a traditional anti-inflammatory medicine like ibuprofen or naproxen, but a COX-2 inhibitor may be a good alternative to reduce side effects.
After this, the next question is which DMARD to use to prevent the ongoing inflammation that harms your joints. Because they’re familiar with it, and because it’s relatively free of side effects, most physicians like to start with methotrexate. Some consider using leflunomide from the beginning, or even the combination of leflunomide and methotrexate, but this has not become common practice. The other medications– infliximab and etanercept–are reserved for only the most severe cases.
You should check with your doctor about which medications you should take if, in fact, you do have rheumatoid arthritis. Keep in mind that most people who get arthritis of the hands and other joints have osteoarthritis, a condition that doesn’t require such powerful drugs. If you’re worried that you may have rheumatoid arthritis, you should check with your physician.
Article By: Craig Gordon MD