Which Is Safer: Methotrexate Or Leflunomide
These two DMARDs have a very similar safety profile, says Dr. Sharmeen. Yet, methotrexate is considered a first-line drug, while leflunomide is a second-line medication. Why? Methotrexate is tolerated better and works a little better for rheumatoid arthritis, she says. Research has shown more improvement when methotrexate is the initial medication. A study published in Rheumatology showed that improvements from methotrexate were more significant after one year than those taking leflunomide for their RA.
Can Ra Go Into Remission
RA remission means your disease is no longer active. For some people, that means they no longer experience RA symptoms, and for others, it could mean symptom-free periods with an occasional, mild flare-up.
Remission should be a long-term goal for you and your healthcare provider, and it is possible to experience it. But because there is no specific definition of remission, it is hard to know exactly how many people with RA experience it.
For example, a 2017 review of RA remission studies published in Therapeutic Advances in Musculoskeletal Disease found that remission rates ranged from 5% to around 45% based on the criteria used to define remission.
That review also shares that people with RA who maintain remission for six or more months have achieved sustained remission. The authors note sustained remission is linked to improved outcomes in function, patient-reported outcomes, and survival.
Your healthcare provider will use measures to determine if you are in remission based on the American College of Rheumatology criteria. These include:
- Less than 15 minutes of stiffness in the morning
- Little or no joint pain, tenderness, or swelling
- Blood tests that show low levels of inflammation
What Is Rheumatoid Arthritis
Rheumatoid arthritis is a chronic disease that can cause pain and swelling in your joints. Rheumatoid arthritis is an autoimmune disease where your immune system doesnt recognise the tissue lining your joints to be part of your body and attacks it. When this happens, some joints become swollen and painful.
Rheumatoid arthritis usually affects smaller joints, such as the joints in your hands and feet, but can also affect large joints like your knees and hips.
Rheumatoid arthritis affects almost 1 in every 50 people in Australia and is more common in women than in men. Rheumatoid arthritis is different from osteoarthritis because it occurs when your immune system attacks your joints, while osteoarthritis is when the cartilage that protects your joints breaks down.
You May Like: How Much Fish Oil Should I Take For Arthritis
What Are The Pros And Cons Of Non
NSAID painkillers can relieve pain in the joints. Examples of these drugs include:
Research has found that they relieve symptoms in about 15 out of 100 people.
The possible side effects of anti-inflammatory painkillers include:
- An upset stomach: in about 3 out of 100 people.
- Ulcers and bleeding in the stomach: in up to 2 out of 100 people who take NSAIDs for a year.
- Cardiovascular disease: in up to 1 out of 100 people who take NSAIDs for a year.
The risk of side effects and complications will depend on various factors, such as the exact medication and dose used. Celecoxib and etoricoxib are less likely to cause stomach problems than other NSAIDs are.
With the exception of acetylsalicylic acid , NSAIDs can somewhat increase the risk of cardiovascular diseases such as heart attacks. This risk is lowest when using naproxen, so naproxen is the most suitable NSAID for people who have both rheumatoid arthritis and a cardiovascular disease.
When used over the long term, NSAIDs can lead to stomach ulcers. These are usually felt as a pain in the upper abdomen. The pain is particularly noticeable just after eating, when the stomach produces more acid. Sometimes stomach ulcers don’t cause any symptoms, and people only find out that they have one if they have serious complications such as bleeding in the stomach.
Jak Inhibitors For Difficult
A drug called tofacitinib is also available. It belongs to a new subclass of DMARDs called JAK inhibitors, which work by blocking another part of the bodyâs immune system response: Janus kinase pathways. This type of DMARD, like conventional DMARDs, can be taken orally.
A study published in April 2019 in the journal Arthritis Research & Therapy found that tofacitinib remained effective for at least eight years and safe for at least nine and a half years.
In June 2018, the Food and Drug Administration approved a drug called Olumiant . It is typically used alongside conventional DMARDs and is for people who have shown poor responses to certain biologics.
Recommended Reading: What Can You Do To Help Arthritis In Your Knees
Which Pain Medication Is Safest For Arthritis Patients
In a recent Alimentary Pharmacology & Therapeutics study, arthritis patients taking nonsteroidal anti-inflammatory drugs for pain plus a stomach acid-reducing medicine called esomeprazole had infrequent gastrointestinal side effects. Co-prescribed with esomeprazole, celecoxib had better overall gastrointestinal safety than ibuprofen or naproxen.
NSAIDs are often used to treat pain and joint inflammation in people with arthritis, but they can cause damage to the intestinal tract including ulcers and bleeding from the stomach or intestine.
In this study, 24,000 arthritis patients were treated with one of three NSAIDscelecoxib, naproxen, or ibuprofenin addition to esomeprazole. Over an average follow-up of nearly 2 years on treatment, serious gastrointestinal tract problems occurred in approximately 3 per 1000 patients on celecoxib and approximately 7 per 1000 on ibuprofen or naproxen.
“Another reassuring finding was that patients who also needed to take aspirin had only slightly more gastrointestinal problems than those who took only the arthritis medications,” said lead author Prof. Neville Yeomans, of the University of Melbourne, in Australia.
What Are The Risk Factors For Developing Rheumatoid Arthritis
There are several risk factors for developing rheumatoid arthritis. These include:
- Family history: Youre more likely to develop RA if you have a close relative who also has it.
- Sex: Women and people designated female at birth are two to three times more likely to develop rheumatoid arthritis.
- Smoking:Smoking increases a persons risk of rheumatoid arthritis and makes the disease worse.
- Obesity: Your chances of developing RA are higher if you have obesity.
You May Like: What Is Biologic Medicine For Rheumatoid Arthritis
What Causes Rheumatoid Arthritis
The exact cause of rheumatoid arthritis is unknown. Researchers think its caused by a combination of genetics, hormones and environmental factors.
Normally, your immune system protects your body from disease. With rheumatoid arthritis, something triggers your immune system to attack your joints. An infection, smoking or physical or emotional stress may be triggering.
Is rheumatoid arthritis genetic?
Scientists have studied many genes as potential risk factors for RA. Certain genetic variations and non-genetic factors contribute to your risk of developing rheumatoid arthritis. Non-genetic factors include sex and exposure to irritants and pollutants.
People born with variations in the human leukocyte antigen genes are more likely to develop rheumatoid arthritis. HLA genes help your immune system tell the difference between proteins your body makes and proteins from invaders like viruses and bacteria.
Best Pain Medication For Severe Arthritis
Arthritis can cause permanent changes to the joint. Although it can affect all people, it occurs most commonly in older people and both men and women in the United States.
This article explores the symptoms of osteoarthritis, treatments, and alternative and home remedies for severe pain.
type of arthritis and causes the most severe pain.
You May Like: Can Arthroscopic Surgery Help Knee Arthritis
What Else You Can Do To Help Relieve Joint Pain
Although strains and sprains can often be the cause of painful joints, there are other causes to watch out for, including cold weather, along with gout, bursitis and arthritis.
- Take regular exercise – it helps build the muscles that support the joint, helping with pain. Choose gentle low impact exercises such as swimming and speak to your GP first if you’re not used to exercise
- Keep to a healthy weight – excess weight can put more stress on joints such as your knees
- Pace your activities and don’t do too much in one go
- Keep warm – many people find their joints hurt more in the cold and wet, so keep well wrapped up
- Alongside your painkillers you can also use a TENS* machine, like the LloydsPharmacy joint pain reliever, and other drug-free products, such as hot and cold packs. To find out more about how TENS machines work and their benefits
Tips On Safer Use Of Otc Painkillers
In short, the safest oral OTC painkiller for older adults is usually acetaminophen, provided you dont exceed 3,000 mg per day.
If you have any concerns about liver function or alcohol use, plan to use the medication daily on an ongoing basis, or otherwise want to err on the safer side, try to not exceed 2,000 mg per day, and seek medical input as soon as possible.
You should also be sure to bring up any chronic pain with your parents doctor. Its important to get help identifying the underlying causes of the pain. The doctor can then help you develop a plan to manage the pain.
And dont forget to ask about non-drug treatments for pain they are often safer for older adults, but busy doctors may not bring them up unless you ask. For example, chronic pain self-management programs can be very helpful to some people.
Now if your older parent is taking acetaminophen often or every day, youll want to be sure youve accounted for all acetaminophen she might be taking. Remember, acetaminophen is often included in medications for cough and cold, and in prescription painkillers. So you need to look at the ingredients list for all medication of this type. Experts believe that half of acetaminophen overdoses are unintentional, and result from people either making mistakes with their doses or not realizing they are taking other medications containing acetaminophen.
Recommended Reading: Is Tommie Copper Good For Arthritis
Treating Spinal Osteoarthritis May Take A Combination Of Therapies
Talk with your doctor about your neck and/or back pain to make sure your diagnosis is accurate and current. Remember that certain types of back problems are degenerative, meaning they may change, improve, or worsen with time. Management of your spinal arthritis pain may involve more than 1 medication or therapy. You have choices, and your doctor can work with you to find the right drug or combination of medications and therapies to ease your spinal osteoarthritis symptoms.
Electrical Nerve Stimulation for Arthritis Pain. Arthritis Foundation Web site. https://www.arthritis.org/living-with-arthritis/treatments/natural/other-therapies/electrical-stimulation-knee.php. Accessed October 29, 2018.
Speak To Your Pharmacist Or Gp About Joint Pain If:
- You have symptoms of arthritis but haven’t been diagnosed
- Your pain isn’t controlled
- You’re on medicines to tone down your immune system and you get symptoms such as a sore throat – seek urgent advice as this may be a sign of a blood disorder
- Your joint pain becomes worse
- There are any changes in your condition
- You regularly buy diclofenac or ibuprofen products
The cold can also make joint and muscles pain worse. Making sure that you wrap up warm during the winter months and ease aching joints with a hot bath or hot water bottle.
If your joint pain is stemming from an injury or strain, try to rest and apply a cold pack for 15-20 minutes every two-three hours during the day. You could also bandage it to contain swelling and keep it raised if possible. It’s best to start using the joint soon to keep it mobile, but always see your GP if there’s no improvement.
*A TENS machine is not suitable for use during pregnancy or labour, or if you suspect you may be pregnant. Its also unsuitable for people with pacemakers or other implanted medical devices or heart rhythm problems. Cancer patients and people with diabetes or epilepsy should seek medical advice before using this product. A TENS machine should not be used without supervision by children under 16 years of age.
Also Check: How Do Doctors Test For Psoriatic Arthritis
Make Healthy Lifestyle Choices
Maintaining a healthy lifestyle will help your physical and mental well being. Doing gentle, regular exercises can help keep your joints flexible, strengthen your bones, help you maintain a healthy weight, relieve emotional stress and create a feeling of general well being. Eat a well-balanced diet with a high intake of whole grains, vegetables, fruits, legumes, nuts, fish and olive oil. There is no specific diet for people with RA and no specific foods to avoid.
Dmards For Treating Rheumatoid Arthritis
There is no cure for RA, but DMARDs are the gold standard of RA treatment.
Each conventional DMARD is different, but they all work by slowing the inflammatory process of the body, protecting the joints from further damage. These drugs are generally prescribed shortly after diagnosis.
Which DMARD your doctor prescribes depends on numerous things, including the severity of the disease and the balance between possible side effects and the benefits of the DMARD. But for many people with RA, DMARDs lose their effectiveness over time, so DMARDs are often combined with other drugs, according to the consumer health information company A.D.A.M.
Recommended Reading: What To Eat For Rheumatoid Arthritis
Also Check: How To Help Rheumatoid Arthritis Pain
Side Effects Are Par For The Course For All Meds But Which Ra Drugs Carry The Least Amount Find Out Here
If you suspect you may have rheumatoid arthritis or your doctor has recently diagnosed youthen youre probably already experiencing the classic symptoms of painful, achy, and swollen joints, especially first thing in the morning or after a long day sitting at work .
Unlike other types of arthritis that can be brought on by too much activity, rheumatoid arthritis symptoms tend to happen when youve been at rest, not using your joints. Maybe you wake up in the morning and feel stiff. Or maybe you get out of the car after a long trip and find your body will barely move. The discomfort in your joints is the result of an overactive immune system that mistakenly attacks the tissue that lines your joints. The result is pain and inflammation and, over time, damage to the joints that can lead to deformity and disability. You may not know anyone else with the disease, but if you have rheumatoid arthritis, youre in good company: RA is the second most common type of arthritis, affecting 1.3 million Americans.
The good news about rheumatoid arthritis is that there are many different treatment options. When someone comes in with rheumatoid arthritis, I tell them that I can get them feeling better and halt the progression of their disease, says Rebecca Blank, MD, Ph.D., a rheumatologist at NYU Langone Health in New York City. The question is, which treatments work best and which ones are safest? Start with these joint-saving options.
Ra Treatment: What Is The Safest Treatment For
- DMARDs, or disease-modifying antirheumatic drugs, are long-term medications meant to slow or alter the progression of rheumatoid arthritis by stopping the immune system from attacking healthy tissue. These drugs protect joints and tissues from permanent damage and gradually reduce daily pain. DMARDs can be taken witâ¦
You May Like: What Blood Tests Can Detect Rheumatoid Arthritis
Be Careful Or Avoid This Common Class Of Painkillers
At the drugstore, the most common alternatives to acetaminophen are ibuprofen and naproxen .
Both of these are part of a class of drugs known as non-steroidal anti-inflammatory drugs . Many people are familiar with these medications. But in fact, older adults should be very careful before using NSAIDs often or regularly.
Unlike acetaminophen, which usually doesnt become much riskier as people get older, NSAIDs have side-effects that are especially likely to cause harm as people get older. These include:
- Increased risk of bleeding in the stomach, small bowel, or colon. Seniors who take daily aspirin or a blood-thinner are at especially high risk.
- Problems with the stomach lining, which can cause stomach pain or even peptic ulcer disease.
- . This can be especially problematic for those many older adults who have already experienced a chronic decline in kidney function.
- Interference with high blood pressure medications.
- Fluid retention and increased risk of heart failure.
Experts have estimated that NSAIDs cause 41,00 hospitalizations and 3,300 deaths among older adults every year.
Recent research has also suggested that NSAIDs cause a small but real increase in the risk of cardiovascular events .
Despite this fact, NSAIDs are often bought by seniors at the drugstore. Perhaps even worse, NSAIDs are often prescribed to older adults by physicians, because the anti-inflammatory effect can provide relief from arthritis pain, gout, and other common health ailments.
Talk To Your Doctor About Ra Treatments
When taking meds, you should discuss a few things with your rheumatologist. For starters, tell your doctor if youre planning to start a family shortly . With some of these medications, you want to be off it for about three months before trying to get pregnant, or trying to get your partner pregnant, says Dr. Blank.
On the other hand, the DMARDs sulfasalazine and hydroxychloroquine are considered safe for pregnancy, so if youre planning to get pregnant, your doctor may start you on one of those. Theoretically, you can be on some TNF inhibitor biologic drugs until your third trimester, says Dr. Sharmeen. But the only one thats safe is Cimzia, she says.
You also want to talk about your lifestyle. For example, if you drink alcohol your doctor will avoid a drug that affects your liver enzymes. And tell your physician if you tend to get a lot of recurrent infections, upper respiratory infections, or are around young children who may pass along infectionsyour doctor may choose a less immunosuppressant drug if your situation makes you more vulnerable to infections. These are all important things for your doctor to know to find the right for you, says Dr. Sharmeen.
Recommended Reading: How To Know You Have Arthritis