There is no cure for Rheumatoid Arthritis. The optimal standard of care practices rely upon a comprehensive program combining medical, social and emotional support for RA sufferers. Most patients are usually treated with a combination of patient education, supplement recommendations for better joint health and protection and a combination of rest, exercise, and physical or occupational therapy to help alleviate additional pain, manage living with and prevent further damage. Medications are usually prescribed once RA has been positively confirmed. More severe cases of RA will sometimes require surgery. Overall, the severity of the RA patient and remission usually dictate the course of care.
What Medications Are Usually Prescribed for Rheumatoid Arthritis?
Medications usually prescribed may include NSAIDs, nonsteroidal anti-inflammatory drugs like ibuprofen (Advil), naproxen (Aleve), aspirin / steroids (prednisone) / DMARDs, disease-modifying antirheumatic drugs (Plaquenil, Azulfidine, Arava, Rheumatrex, Trexall) / and a new class of DMARDs called BRMs, biological response modifiers (Enbrel, Humira, Remicade, Actemra). Due to the concern of long term cartilage damage and bone erosion within first two years of this disease, your rheumatologist usually involves DMARDs early in treatment, often as soon as a diagnosis is confirmed. It is not uncommon for these drugs to be used as part of a regimen and in combination with each other.
What are Disease Modifying Antirheumatic Drugs (DMARDs) and How Do They Work?
DMARDs, disease-modifying antirheumatic drugs, is a particular class of drugs that are classified as such because they are known to alter the course of RA by slowing or stopping the disease from progressing. While more commonly known, available and widely used NSAIDs and steroids can be helpful with pain relief and inflammation associated with RA, they have not been successful in long term treatment of RA progression.
Most DMARDs work by interrupting or blocking certain compound chemicals or effects on other inflammatory and immunoregulatory pathways utilized during biochemical processes within the body, but some are thought to change antigen presentation or effects on the innate immune system. DMARDs like Rheumatrex and Trexall (methotrexates) are widely considered a typical first-line treating agent for RA. When compared to other DMARDs in patients studies methotrexate can be taken for extended periods of time both efficaciously and with great tolerability compared to other DMARDs (like Rheumatrex and Trexall) that vary in composition and approach. In some cases, methotrexates have been shown to be as effective as some single therapy BRMs (Enbrel, Humira, Remicade, Actemra). The side effects and risks of DMARDs can vary greatly depending on which drug is used and based on underlying health conditions of patients and should be reviewed individually for such between physicians and patients.
DMARDs are administered under physician care and are generally in the form of pills, tablets, infusions or injectables.
What Are Biological Response Modifiers (BRMs) and How Do They Work?
Biological response modifiers are a newer class of DMARDs and are substances that modify immune responses within the body. BRMs can be produced naturally within the body or as pharmaceutical drugs and can either enhance or suppress immune responses by increasing the body’s response to infections or preventing the body’s response from becoming excessive. When used to treat Rheumatoid Arthritis the goal of the BRM is to reduce the body’s response to inflammation and to prevent it from becoming excessive where it may exist. Most commonly used BRMs do this by blocking cytokines, the proteins needed to cause an immune response in the joint tissues and fluids. Cytokines are naturally produced in the body’s joints and are commonly referred to as tumor necrosis factor alphas (TNFs). TNFs are responsible for creating inflammation in RA suffers.
Medications like ENBREL, REMICADE and HUMIRA block TNFs from being produced and are referred to as TNF inhibitors. Enbrel was the first TNF inhibitor and was introduced as the first BRM-TNF inhibitor in 1998.
Following the advent of TNF inhibitors, other BRM inhibitors and antagonists like ACTEMRA and KINERET (Tocilizumab and Anakinra) have been marketed for the treatment of RA. These brands work to alter different proteins called Interleukins (IL-6 and IL-1) in the body and while they may be included in the treatment of nonresponsive cases of RA, they are not considered first-line BRMs in the treatment of RA.
Other BRMs (like Orencia, Rituxan) have been manufactured for RA treatment and work by altering specific cell functions within the immune response process and may be introduced once BRM inhibiting treatments have failed a patient.
All BRM treatments available on the market to date are administered by injection at the site of swelling or via intravenous (IV) lines and are single dose treatments administered by or under physician care during the course of RA treatment.
The same as with DMARDs, side effects of BRMs can be specific to each drug and underlying health conditions, therefore each drug should be examined individually.
Some RA Drugs Have Been Proven to Be Dangerous
Actemra is a relatively new drug that's prescribed primarily for the treatment of Rheumatoid Arthritis. However, newly published research indicates that Actemra can lead to dangerous and even deadly side effects including stroke and heart attack. Learn more about the risks of Actemra here.