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Grappling with Rheumatoid Arthritis

Affecting about 1% of the world population, rheumatoid arthritis (RA) is a chronic inflammatory disorder of the joints that most commonly affects the hands and feet.

In addition to painful swelling, typical symptoms include fever, fatigue, bone erosion, and even joint deformity.  The condition develops most frequently between the ages of 20-40, with increased chances over the age of 55.

Recently, extensive research reviews of medication for RA have been undertaken and published by the European League Against Rheumatism (EULAR).

Individuals must be informed of the treatment options available, and discuss them with their medical service providers in order to obtain the most efficient healthcare.  Below we examine the available options of treatment and their efficacy for patients with RA.

Disease-modifying anti-rheumatic drugs (DMARDs) are the most widely recommended drugs for the initiation of treatment and should be prescribed as soon as RA is diagnosed.

These drugs are classed into two groups: synthetic and biological.

Synthetic drugs are the first choice among doctors as their risks and side effects have been extensively studied and chances of overtreatment are minimized.

Some synthetic DMARDs available in Canada and U.S. are:

  1. Methotrexate  – taken singly or in combination with other synthetic DMARDs, Methotrexate has been shown to be the most effective, inexpensive, and safe drug for long-term use.  Some side effects are possible, including rashes, upset stomach, liver and bone marrow toxicity, birth defects, and shortness of breath.  Regular monitoring by a medical professional is crucial.  Taking folic acid may reduce some of the side effects.
  2. Plaquenil and Sulfasalazine – best for mild RA, this option has fewer side effects.  However, one potential hazard is eye damage and patients should visit an ophthalmologist at least annually.
  3. Minocycline – an antibiotic that may stop inflammation, but takes a few months to a year to begin working.  Long-term use may cause skin discoloration.
  4. Arava and Leflunomide – are similar to, and work well in combination with, Methotrexate.  Side effects may include diarrhea and fetus damage.

Patients who don’t respond well to the above treatments are offered the option of biological DMARDs.

These include Enbrel, Actemra, Humira, Kineret, Orencia, Remicade, Rituxan, Cimzia, and Simponi. Administered directly by injection, rapid biologics commence their action within 2-6 weeks and are most effective when taken in conjunction with Methotrexate.

Although they possess fewer side effects than synthetic DMARDs, some risk of severe infections and low liver and blood counts exists.

The major disadvantage of biologics is that they are quite new, and proper evaluation of long-term side effects is not yet available.  In patients suffering from a persistent resurgence of RA, care must be taken to taper biologics, especially when used in combination with synthetic DMARDs.

For patients with severe RA, glucocorticoids or steroids may be a short-term option.

Administered by injection or orally, along with other DMARDs, these work best for flare-ups and when quick relief of swelling is necessary.

The various side effects consist of weight gain, an increase in diabetic symptoms, cataracts, osteoporosis, and infections.

It is recommended that patients suffering from RA visit a rheumatologist every 1 – 3 months and modify their medication every 3 – 6 months if no improvement occurs with the present prescriptions.

Smolen, J.S. et al.  EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs. Annals of Rheumatic Diseases: The EULAR Journal.  Available from: http://ard.bmj.com/content/early/2010/05/04/ard.2009.126532.abstract. Last accessed: July 2013.Chronic diseases and health promotion: chronic rheumatic conditions. World Health Organisation. Available from: http://www.who.int/chp/topics/rheumatic/en/. Last accessed: July 2013.Treating rheumatoid arthritis with disease-modifying drugs (DMARDs). WebMD. Avalaible from: http://www.webmd.com/rheumatoid-arthritis/guide/dmard-rheumatoid-arthritis-treatment.  Last accessed July 2013.

Patient information: rheumatoid arthritis treatment (beyond the basics).  UpToDate.  Available from http://www.uptodate.com/contents/rheumatoid-arthritis-treatment-beyond-the-basics#H10.  Last accessed: July 2013.

Written by Julia Yusupova



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