Rheumatoid arthritis is an inflammatory disease that causes joint pain and stiffness. It can also damage your joints and other parts of your body. The goals of rheumatoid arthritis treatment are to control inflammation, ease pain, and reduce disability.
Treatment usually includes medications, occupational or physical therapy, and exercise. Some people need surgery to correct joint damage. Early treatment is key to good results. With today’s treatments, joint damage can often be slowed or stopped.
Rheumatoid Arthritis Medications
Several kinds of drugs are used for rheumatoid arthritis treatment. Here are main types.
NSAIDs
Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce pain and inflammation but don’t slow RA. If you have moderate to severe RA, you’ll probably need additional drugs.
Many NSAIDs come as pills or tablets. Over-the-counter NSAIDs include ibuprofen and naproxen. Most people with RA need a prescription version, like celecoxib (Celebrex), which can provide higher doses with longer-lasting results with fewer doses each day.
Side effects of NSAIDS. Prescription NSAIDs carry a warning about the higher risk of heart attack and stroke. NSAIDs can also raise blood pressure and can cause stomach irritation, ulcers, and bleeding.
DMARDs
DMARDs are disease-modifying antirheumatic drugs. They curb your immune system to help slow RA or keep it from getting worse.
Doctors usually first prescribe methotrexate (Rheumatrex, Trexall) to treat rheumatoid arthritis. If that doesn’t calm the inflammation, they may add or switch to a different type of conventional DMARD such as hydroxychloroquine (Plaquenil), leflunomide (Arava), sulfasalazine (Azulfidine), or tofacitinib (Xeljanz).
You can take DMARDs as a pill, but some people get methotrexate as a shot. It may take a few weeks or months to start working, and longer to get the full effect.
Side effects of DMARDs. A weakened immune system can lead to infection. Some DMARDs can cause liver damage. Leflunomide and methotrexate can cause birth defects. If you’re planning to start a family, talk with your doctor first.
Biologics
When methotrexate or other conventional DMARDs don’t ease RA symptoms and inflammation, doctors may recommend a biologic. These are genetically engineered proteins. They block specific parts of the immune system that play a key role in the inflammation of rheumatoid arthritis. These drugs can work quickly to ease joint pain and swelling.
- Related:Alternative Treatments for RA
Many biologics block TNF, a chemical your body makes that causes inflammation. Other biologics target other chemicals — like IL-1 or IL-17.
Biosimilar drugs are now available for some of these biologics. These are close copycats of the original drugs, made with the same types of living materials. You get them the same ways and they’re proven to be as effective and safe as the biologics at the same dosage. A biosimilar may cost you less, but it can depend on your insurance. You should talk with your doctor about the pros and cons of switching from a biologic to a biosimilar drug.
Some of the biologic and biosimilar drugs available to treat RA include:
Biologic rheumatoid arthritis drugs
- Abatacept (Orencia)
- Adalimumab (Humira)
- Anakinra (Kineret)
- Certolizumab (Cimzia)
- Etanercept (Enbrel)
- Golimumab (Simponi, Simponi Aria)
- Infliximab (Remicade)
- Rituximab (Rituxan)
- Sarilumab (Kevzara)
- Tocilizumab (Actemra)
Biosimilar rheumatoid arthritis drugs
For adalimumab:
- Adalimumab-adaz (Hyrimoz)
- Adalimumab-adbm (Cyltezo)
- adalimumab-afzb (Abrilada)
- Adalimumab-atto (Amjevita)
- Adalimumab-bwwd (Hadlima)
- Adalimumab-fkjp (Hulio)
For etanercept:
- Etanercept-szzs (Erelzi)
- Etanercept-ykro (Eticovo)
For infliximab:
- Infliximab-axxq (Avsola),
- Infliximab-abda (Renflexis)
- Infliximab-dyyb (Inflectra)
- infliximab-qbtx (Ixifi)
You may take biologics by injection at home, by IV in a medical center, or as a pill.
Side effects of biologics and biosimilars. Because they slow your immune system, biologics make it harder for you to fight infection. They can cause flare-ups of some infections that aren’t active, like tuberculosis. Some people have reactions at the IV or injection site. Other IV reactions may include chest pain, trouble breathing, and hives. Each drug has its own side effects that you should discuss with your doctor.
