What Drugs Are Used To Treat Rheumatoid Arthritis
The drugs used to treat rheumatoid arthritis can be divided into three groups:
- Drugs that decrease pain and inflammation. These products include non-steroidal anti-inflammatory drugs , such as ibuprofen , naproxen , and other similar products. Another type of drug the COX-2 inhibitor also falls into this drug category, providing relief of the signs and symptoms of rheumatoid arthritis. Celecoxib , one COX-2 inhibitor, is available and used in the United States. The COX- 2 inhibitors were designed to have fewer bleeding side effects on the stomach.
- Disease-modifying antirheumatic drugs . Unlike other NSAIDs, DMARDs can actually slow the disease process by modifying the immune system. Older DMARDs include methotrexate , gold salts, penicillamine , hydroxychloroquine , sulfasalazine , cyclosporine , cyclophosphamide and leflunomide . Currently, methotrexate, leflunomide, hydroxychloroquine, and sulfasalazine are the most commonly used. Many of these drugs were first used to treat other medical conditions such as malaria, transplant rejection, cancer, psoriasis and inflammatory bowel disease but have now also found a role in treating rheumatoid arthritis.
Challenges In Managing And Preventing Rheumatoid Arthritis Pain
Yvette C. Terrie, BS Pharm, RPhClinical Pharmacist/Freelance Medical WriterHaymarket, Virginia
US Pharm.
ABSTRACT: Rheumatoid arthritis is a prevalent chronic, progressive, inflammatory autoimmune disease that affects not only the joints but also other organs, including the eyes, heart, and lungs. It is characterized by painful, tender, and swollen joints that can significantly affect a patients quality of life and productivity due to pain, stiffness, and sleep disturbances. Pain is often reported as the most debilitating symptom associated with RA. Pharmacologic therapies used in the treatment and management of RA include nonbiologic and biologic disease-modifying antirheumatic drugs and adjunctive agents such as immunosuppressants, corticosteroids, nonsteroidal anti-inflammatory drugs, and other analgesics. Pharmacists can educate patients and make clinical recommendations when warranted to improve clinical outcomes.
An estimated 1.5 million individuals in the United States have RA.3 Globally, the incidence of RA is about 0.5% to 1% in developed countries and 0.6% in the United States population.3,4 Statistics from various healthcare organizations also indicate that women are two to three times more likely to develop RA when compared with men, with the greatest incidence of RA occurring in women aged 65 years and older.3-6 Moreover, 75% of RA cases are diagnosed in women, and estimates are that 1% to 3% of women will develop RA at some point in their lifetime.7-9
What Are The Symptoms Of Rheumatoid Arthritis
The most common symptoms of rheumatoid arthritis include:
- swelling, pain and heat in the joints, usually starting in the smaller joints of the hands or feet
- stiffness in the joints, especially in the morning
- persistent mental and physical tiredness
- the same joints on both sides of the body being affected
Less common symptoms may include weight loss, inflammation of other body parts or rheumatoid nodules .
Rheumatoid arthritis can occur at any age, but usually appears between the ages of 30 and 60. It affects women more often than men.
The course and severity of rheumatoid arthritis varies from person to person. Symptoms may change from day to day.
At times your symptoms may become more intense. This is a flare, or flare-up. Flares are unpredictable and can seem to come out of nowhere.
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Exercise For Ra Pain Management
The pain and stiffness of RA often causes people with the disease to become less active. In fact, 71 percent of people with RA don’t exercise regularly, according to research published in the journal Sports Medicine. But poor physical fitness only worsens symptoms.
An exercise plan designed by an experienced physical or occupational therapist can help relieve RA symptoms, including pain, and increase quality of life. It can also help you maintain a proper weight, taking further pressure off your joints.
The exercise regimen for RA should include a combination of low-impact aerobic exercises, flexibility exercises, strengthening exercises, and body awareness exercises, according to the American College of Rheumatology.
High-intensity interval training, barre work , and spinning may also be beneficial exercises for people with RA.
Additionally, Pilates, a low-impact physical fitness technique, can strengthen abdominal muscles, taking pressure off painful joints and improving flexibility and mobility in people with RA. Pilates can also strengthen the muscles around joints, possibly reducing pain.
It’s also important to pay special attention to hand and foot exercises. Research published in the journal British Medical Bulletin found that resistance exercises involving the hands improved hand pain, as well as hand function, grip strength, and range of motion in people with RA.
Evening Primrose Oil Supplements
Some plant oils may reduce pain and stiffness associated with RA. Evening primrose oil contains an essential fatty acid called gamma-linolenic acid that may provide some relief.
A 2016 study found that taking evening primrose oil and fish oil may reduce inflammation and disease activity.
According to the National Center for Complementary and Integrative Health , however, more research is needed on the effectiveness of primrose oil.
Again, check with your doctor before taking evening primrose oil, as it may interact with some medications. Potential side effects include headache and an upset stomach.
Thunder god vine grows in China and Taiwan and is used in traditional Chinese medicine. Research has indicated that it may be effective for treating RA symptoms.
According to a 2015 study , thunder god vine was comparable to the standard RA drug methotrexate in relieving symptoms. The study found that taking both was even more effective.
A 2018 research review also suggested that thunder god vine supplements may help reduce inflammation. Still, more research is needed on long-term effects and safety.
Talk to your doctor and assess the benefits before trying thunder god vine, as it may have some serious side effects. These can include reduced bone mineral content, infertility, rashes, and hair loss.
Thunder god vine can also be poisonous if it isnt prepared correctly.
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Are There Guidelines About The Use Of Cbd For Chronic Arthritis Pain
Until recently, little guidance has been available for people with arthritis pain who were interested in CBD treatment. Depending on availability and interest, patients and their doctors had to decide on their own whether CBD was a reasonable option in each specific case. To a large degree thats still true, but some guidelines have been published. Heres one set of guidelines for people pursuing treatment with CBD that I find quite reasonable :
Dos:
- If considering a CBD product, choose one that has been independently tested for purity, potency, and safety for example, look for one that has received a Good Manufacturing Practices certification.
- CBD should be one part of an overall pain management plan that includes nonmedication options and psychological support.
- Choose an oral treatment and start with a low dose taken in the evening.
- Establish initial goals of treatment within a realistic period of time for example, a reduction in knee pain that allows you to walk around the block within two weeks of starting treatment later, if improved, the goals can be adjusted.
- Tell your doctor about your planned and current CBD treatment monitor your pain and adjust medications with your medical providers, rather than with nonmedical practitioners .
Donts:
Other Therapies For Ra
Taking your medication is just one thing you can do to help you feel your best. Consider assembling a team of medical specialists from a variety of fields, like psychiatry, sleep medicine, physical or occupational therapy, or nutrition, who can support you wherever you may need it. Areas they can help with:
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What Are The Complications Of Ra
Rheumatoid arthritis has many physical and social consequences and can lower quality of life. It can cause pain, disability, and premature death.
- Premature heart disease. People with RA are also at a higher risk for developing other chronic diseases such as heart disease and diabetes. To prevent people with RA from developing heart disease, treatment of RA also focuses on reducing heart disease risk factors. For example, doctors will advise patients with RA to stop smoking and lose weight.
- Obesity. People with RA who are obese have an increased risk of developing heart disease risk factors such as high blood pressure and high cholesterol. Being obese also increases risk of developing chronic conditions such as heart disease and diabetes. Finally, people with RA who are obese experience fewer benefits from their medical treatment compared with those with RA who are not obese.
- Employment. RA can make work difficult. Adults with RA are less likely to be employed than those who do not have RA. As the disease gets worse, many people with RA find they cannot do as much as they used to. Work loss among people with RA is highest among people whose jobs are physically demanding. Work loss is lower among those in jobs with few physical demands, or in jobs where they have influence over the job pace and activities.
Hand Therapies For Rheumatoid Arthritis
When rheumatoid arthritis affects your hands and wrists, a variety of treatment options are available to help relieve pain, offer better mobility and prevent joint deformity.
With its 29 joints and intricate network of muscles, ligaments and tendons to support them, the human hand is capable of exacting tasks such as performing surgery or playing the violin. But with arthritis, even the simplest of tasks can become difficult or painful. For rheumatoid arthritis of the hands, treatment includes good medical management, along with occupational therapy interventions for some. This could mean using splinting and adaptive aids to reduce deforming stresses on the joints of the hands and maintain mobility. Finally, if joint damage has occurred, surgery may be an option.
Medications
Assistive Devices and Occupational Therapy
Exercises
In many cases, strengthening and stretching exercises, as prescribed by an occupational or physical therapist can also help relieve symptoms and improve function. In a 2016 study published in Arthritis Care & Research, 242 people with hand RA were randomly assigned to continue their regular treatment, while 246 were assigned to a program of exercises designed to improve a variety of hand and wrist movements. Researchers found improvements in grip strength at 4 months predicted improved hand function at 12 months.
Surgery
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Natural Remedies For Rheumatoid Arthritis
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Rheumatoid arthritis is an autoimmune disease that can significantly reduce a persons quality of life. Medications can help manage symptoms, and some people also benefit from natural remedies.
Several medication-free measures can help reduce the discomfort of rheumatoid arthritis .
In 2014, RA affected 1.281.36 million adults in the United States, according to research published in 2017.
This article covers a range of natural remedies for RA symptoms, as well as dietary and lifestyle changes that can help.
According to clinical guidelines published in 2011, targeted physical therapy can benefit people with RA. This may involve stretching, exercise, and alternating between hot and cold.
How To Handle Rheumatoid Arthritis Pain
While you may not be able to avoid the pain that comes with rheumatoid arthritis , you can take action to limit it. Start with these eight ideas:
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Medical Marijuana For Ra Joint Pain
While is often prescribed for chronic pain, research suggests that cannabis has a worse risk-to-benefit profile than all other pain-relieving medication, save for opioids. That is, though it generally reduces pain, cannabis’ mental and heart-related side effects make some rheumatologists apprehensive to prescribe it for rheumatic conditions.
But the benefits and risks of medical marijuana for RA vary depending on the mode of transmission.
For example, topical CBD oil can provide immediate pain relief for a few hours, but the need to reapply can make the treatment expensive. Edibles, on the other hand, can provide medicinal effects for up to 8 hours , but the dosages are inconsistent and the effects can vary between uses.
Rheumatologists discourage RA patients from smoking marijuana because smoking carries risks for many diseases, particularly heart and lung disease. In general, one should never smoke anything the toxins can hurt your lungs and cause permanent damage.
Medication And Supplements For Rheumatoid Arthritis Pain
Medication is the standard treatment for RA. Most often, doctors will prescribe disease-modifying anti-rheumatic drugs, or DMARDs, after diagnosing a person with RA.
These drugs, including newer versions called biologic DMARDs, slow the progression of the disease and reduce inflammation and symptoms. But they are not used for acute pain management.
For joint pain, doctors instead recommend nonsteroidal anti-inflammatory drugs , such as Aleve and prescription Diflunisal , and corticosteroids, such as prednisone and prednisolone. These drugs, particularly corticosteroids, can quickly improve joint pain and other symptoms of RA. Taking NSAIDs may pose risks related to heart, kidney, and GI health. Ask your doctor if it makes sense for you to start over-the-counter or prescription NSAIDs first.
Research suggests some supplements may be helpful for RA-related joint pain.
Omega-6 fatty acids, particularly gamma-linolenic acid , found in evening primrose oil, borage seed oil, or black current seed oil, is “probably” effective at improving RA pain, according to a review published in the Cochrane Journal of Systematic Reviews.
Fish oil, which contains high levels of omega-3 fatty acids, may also ease symptoms of rheumatoid arthritis. Research published in the Journal of Nutrition found that omega-3 fatty acids can help reduce joint swelling and pain, morning stiffness, and the need for anti-inflammatory drugs in people with RA .
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Editorial Sources And Fact
A Warning About Supplements
A few RA studies show that certain supplements and natural remedies can help. But the research is still in its early stages, so the bottom line isnât clear yet.
Keep in mind that supplements can affect other medications. Tell your doctor about anything you take, even if itâs natural, so they can check that itâs safe for you.
Show Sources
NCCAM: “Rheumatoid Arthritis and Complementary and Alternative Medicine ” “The Use of Magnets for Pain” and “Thunder God Vine.”
Session 3: Joint Nutrition Society and Irish Nutrition and Dietetic Institute Symposium on “Nutrition and autoimmune disease” PUFA, inflammatory processes and rheumatoid arthritis.
Arthritis Today: “Supplement Guide.”
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Be Active And Exercise
There is no doubt that exercise remains one of the surest ways to quiet arthritis. Physicalactivities are suitable for increasing flexibility and strength, helping to boost energy and relieveyou of any pains you may be having. According to the Center for Arthritis & Osteoporosis,adults who are only battling arthritis need to partake in mild-intensity aerobic exercises for aminimum of 150mins and two strength-focused pieces of training weekly.
Tumor Necrosis Factor Inhibitors
Tumor necrosis factor alpha is a pro-inflammatory cytokine produced by macrophages and lymphocytes. It is found in large quantities in the rheumatoid joint and is produced locally in the joint by synovial macrophages and lymphocytes infiltrating the joint synovium. TNF is one of the critical cytokines that mediate joint damage and destruction due to its activities on many cells in the joint as well as effects on other organs and body systems. TNF antagonists were the first of the biological DMARDS to be approved for the treatment of RA. These drugs began to enter the market for rheumatoid arthritis in 1999 and are now considered a part the ACR recommendations for treatment of RA. There are currently five TNF inhibitors FDA approved for the treatment of RA etanercept , infliximab , adalimumab , certolizumab pegol , and golimumab . Etanercept is a soluble TNF receptor-Fc immunoglobulin fusion construct infliximab, adalimumab, and golimumab are monoclonal antibodies and certolizumab pegol is an anti-TNF antigen binding domain-polyethylene glycol construct. While differing in structure, the efficacy and safety of the drugs is similar across the class in reducing the signs and symptoms of RA, as well as in slowing or halting radiographic damage, when used either as monotherapy or in combination with methotrexate.
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