Most people who have rheumatoid arthritis take some kind of medication. Medicines for RA are usually divided into five categories: non-steroidal anti-inflammatory drugs (NSAIDs); steroids; anti-rheumatic modifying drugs; biologics and Janus kinase inhibitors. In this article, we will consider the treatment of rheumatoid arthritis with medicines.
When prescribing medicine, the doctor takes into account the patient’s age, the activity of the disease and other medical conditions, but each patient is unique. Finding out which medicine or combination of drugs is best for the person can be challenging and often requires trial and error.
Medication for rheumatoid arthritis
Most people with RA are advised to take non-steroidal anti-inflammatory drugs to reduce pain and inflammation. NSAIDs are sold over the counter under the names Advil and Aleve, as well as over the counter under such names as Mobis and Celebrex.
- Steroids (corticosteroids).
Fast-acting steroids such as prednisone are especially useful during initial treatment before other RA drugs take effect (often 12 weeks or more).
One of the benefits of steroids is that they can be injected into the joints. Injected steroids can have on one or two painful joints with limited side effects.
Experts recommend taking the lowest possible dose of steroids and advising you not to rely on them for longer than necessary. The effectiveness of steroids often decreases over time, which means that the longer a person takes steroids, the less likely it is to alleviate symptoms. In addition, people who take steroids continuously for several months or years may experience side effects such as weight gain, high blood pressure, diabetes, and heart disease.
- Methotrexate and other traditional drugs.
Disease-modifying anti-rheumatic drugs are used to slow or stop rheumatoid arthritis by suppressing the immune system. Common names include:
Methotrexate is often the first drug prescribed for people newly diagnosed with rheumatoid arthritis. RA patients take this drug weekly, alone or in combination with other drugs.
High-dose methotrexate is also used to treat certain types of cancer. RA patients take significantly lower doses than cancer patients.
- Biological products for rheumatoid arthritis.
This class of drugs, called biological response modifiers, is technically a subset of drugs. They can be used with traditional drugs or as an alternative to them. Biological products:
- Disrupt certain parts of the cascade of events that lead to inflammation of the RA and can stop the disease process.
- They increase the risk of human infection and are usually expensive. Because of these potential drawbacks, biologicals are used when methotrexate or other drugs are inadequate or cause unacceptable side effects.
- May become less effective or cause worsening side effects over time. The doctor and patient can work together to monitor the changes and decide whether the transition of drugs is appropriate.
Biological preparations are divided into four categories: inhibitors of tumor necrosis factor; Interleukin inhibitors; B cell inhibitors; And T cell inhibitors. These drugs are administered by injection or infusion. Examples include Remicade, Enbrel, and Humira.
Testing for tuberculosis.
Before taking any biological drugs, you need to pass a test for tuberculosis. People with latent tuberculosis carry the bacterium without symptoms of tuberculosis. If a person with latent tuberculosis takes immunosuppressive biological drugs, the bacterium can multiply and cause symptomatic tuberculosis.
- Inhibitors of Janus Kinase.
Janus Kinases – Enzymes are important messengers in the inflammatory process of the immune system. When Janus Kinase enzymes bind to other cells called X cells, they cause inflammation. Janus Kinase inhibitors bind to enzymes, inhibiting their binding to X cells and stopping the inflammatory process.
The first approved Janus Kinase inhibitor is called Tofacitinib, and it is marketed under the names Xelians and Xelyans XR (extended-release).
As with biological mediators, people taking Janus Kinase inhibitors should be tested for tuberculosis.
People taking Janus Kinase inhibitors are advised to work with their doctors to monitor risks and side effects.