Rheumatoid Arthritis

The goals of rheumatoid arthritis (RA) treatment are to:

  • Stop inflammation (put disease in remission)
  • Relieve symptoms
  • Prevent joint and organ damage.

RA is often treated with three main drug types:

  • Non-steroidal anti-inflammatory drugs (NSAIDs), which help reduce pain and swelling. These include aspirin, ibuprofen and naproxen. COX-2 inhibitors such as meloxicam and celecoxib are also helpful NSAIDs.
  • Corticosteroids also help reduce pain and swelling. Some examples are Solu-Medrol as well as dexamethasone or prednisone.
  • Disease-modifying anti-rheumatic drugs (DMARDs) are non-biological and biological response modifiers that may be taken by mouth or injected.

Disease-modifying anti-rheumatic drugs (DMARDs)

Traditional systemic therapies are oral prescription medications that circulate throughout the entire body.

Methotrexate
suppresses the immune response in RA. Improvement may not show for 3 to 6 weeks after starting this therapy and maximum improvement may take up to 6 months. Methotrexate is usually taken once a week, either in oral form or by injection. Methotrexate may be added to other non-biological or biological DMARDs and continued chronically in certain patients to keep RA under control. In such patients, regular blood testing and liver monitoring is needed to ensure the drug is being processed safely by the body. While taking methotrexate, many providers recommend taking folic acid 1 mg daily or folinic acid 5 mg weekly to reduce the risk of certain methotrexate side effects, such as upset stomach and a sore mouth.

  • Common side effects: tiredness, difficulty sleeping, lightheadedness, mouth ulcers-could indicate dose too high, vomiting, headache, easy bruising and bleeding, fever, chills, diarrhea with blood in stool, sensitivity to light, burning sensation in lesions, and hair loss.
  • Contraindications: people suffering from alcoholism, liver disease, immunodeficiency syndromes, pregnant or nursing mothers, men or women attempting a pregnancy, people with active peptic ulcers, significant kidney abnormalities, active infectious disease or pre- existing blood problems, should not take

Hydroxychloroquine (Plaquenil®)
suppresses the immune response in RA. Improvement may not show for 3 to 6 weeks after starting this therapy and maximum improvement may take up to 6 months. Hydroxychloroquine is usually taken once daily by mouth. It is typically used in patients who cannot tolerate methotrexate and may be added to other non-biological or biological DMARDs and continued chronically in certain patients to keep RA under control. In such patients, regular blood cell count and eye exams every 3 months are needed to ensure the drug continues to be safe and tolerable.

  • Common side effects: visual sensitivity to light, reading/seeing difficulties, seeing light flashes or streaks, difficulty hearing, ringing in the ears, muscle weakness, and rash.
  • Contraindications: hypersensitivity to 4-aminoquinoline compounds, long-term use in children, retinal or visual field changes from prior 4-aminoquinoline compound.

Leflunomide (Arava®)
suppresses the immune response in RA. Improvement may not show for 3 to 6 weeks after starting this therapy and maximum improvement may take up to 6 months. Leflunomide is usually taken once daily by mouth. It is typically used in patients who cannot tolerate methotrexate and may be added to other non-biological or biological DMARDs and continued chronically in certain patients to keep RA under control. In such patients, regular blood testing and liver monitoring is needed to ensure the drug is being processed safely by the Blood pressure and routine TB screening are also recommended.

  • Common side effects: diarrhea, nausea, stomach pain, rash, and hair loss.
  • Contraindications: concomitant treatment with teriflunomide, hypersensitivity to leflunomide or any components of the product, pregnancy, and severe hepatic (liver) impairment.

Sulfasalazine (Azulfidine®)
suppresses the immune response in RA. Improvement may not show for 3 to 6 weeks after starting this therapy and maximum improvement may take up to 6 months. Sulfasalazine is usually taken once or twice daily by mouth. It is typically used in patients who cannot tolerate methotrexate and may be added to other non-biological or biological DMARDs and continued chronically in certain patients to keep RA under control. In such patients, regular blood testing, renal function and liver monitoring is needed to ensure the drug is being processed safely by the Improvement in number and extent of actively inflamed joints and erythrocyte sedimentation rate (ESR-test that detects inflammation) or C-reactive protein can be used to evaluate therapeutic response.

  • Common side effects: nausea, abdominal discomfort, headache, skin rash, mouth sores, and itching.
  • Contraindications: hypersensitivity to sulfasalazine, its metabolites, sulfonamides, or salicylates, intestinal or urinary obstruction, porphyria.

Immune modifiers
such as azathioprine and cyclophosphamide may also be used, especially in patients with psoriatic arthritis who have not responded to methotrexate and/or topical therapies.

  • Common side effects: nausea, vomiting, diarrhea, increased risk of infection, decreased white blood cell counts, and liver damage; however, side effects can be serious and vary depending on the medication.

Overcoming Medication Challenges

It is important for you to know the benefits of your medications. Here at Magellan Rx, we understand your concerns and want to help you with any difficulties you may encounter. For additional information on how to overcome medication challenges, please click here: Overcoming Medication Challenges