Video Q & A:

RA Medication Basics


Which drug combinations work best for RA treatment?

Expert:   Linda Russell, MD, Hospital for Special Surgery »

Rheumatologists play matchmaker with your rheumatoid arthritis medications. Some drug combinations work better than others, depending on the patient. Find out which are the most common choices.

Transcript: DMARDs make up the CHIEF component of most rheumatoid arthritis treatment plans. These disease-modifying anti-rheumatic drugs actually SLOW OR HALT the progress of the disease and SOMETIMES, put it into remission. They have the ability to save you from years of pain and long-term joint damage. It’s likely that your doctor will start you on methotrexate, the most-often prescribed DMARD. But, OFTEN, you’ll eventually graduate to a COMBINATION of DMARDs. There are many possible dual or triple DMARD combos your doctor can choose from—he or she will base his decision on your medical history and symptoms. 4 DMARDs are involved in these combinations—BESIDES methotrexate, there is leflunomide, hydroxychloroquine, and sulfasalazine. Etanercept and adalumimab are examples of ANOTHER group of DMARDs – biologic response modifiers. If your rheumatoid arthritis is in the early stages and you have low to moderate symptoms, you’re NOT yet a candidate for biologic drugs. Unlike traditional DMARDs, biologics are engineered from human proteins and they target MOLECULAR components of your overactive immune system. There are 9 approved biologics, but or tumor necrosis factor-inhibitors are the MOST commonly prescribed type of biologic. They ease inflammation by targeting TNF alpha, a pro-inflammatory molecule that attack cells in the joints of people with rheumatoid arthritis. Sometimes you may use a combination of a traditional DMARD like methotrexate and a biologic. This may be particularly effective for people who haven’t responded to DMARDs alone OR whose RA is severe. Many rheumatologists consider this combo the best way to slow the progression of the disease. Biologics however are NEVER prescribed together. Taking TWO at the same time may drastically increase your risk of serious infection. The benefits of DMARDs may kick in after about four to six weeks. While you’re WAITING , your doctor may prescribe nonsteroidal anti-inflammatory drugs, known as NSAIDS, to ease your pain and inflammation. These can be over-the-counter medications such as ibuprofen or naproxen sodium, or prescription celecoxib, which may be easier on the stomach (but harder on the heart). Corticosteroids such as prednisone, prednisolone and methyprednisolone are also antinflammatory drugs that can rapidly reduce redness and swelling around joints and ease pain. They are also useful while waiting for DMARDs to begin working. Since there are so many drug therapy combinations, it might take some trial and error to find the one that works best for YOU. Don’t be discouraged. RA can be well managed and you can preserve your quality of life. For more on rheumatoid arthritis, look for other videos in this series. More »

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