Talk To Your Doctor To Find A Rheumatoid Arthritis Treatment That Works For You
The goal of rheumatoid arthritis treatment is to get you to a place where you are as comfortable as possible. We want to make feel as if they dont have rheumatoid arthritis, Dr. Singh says. But getting to a state of low disease activity or remission is a process that wont look the same for everyone.
A lot of factors come into play when searching for a treatment that works, including the severity of your illness, the most up-to-date treatment recommendations from the American College of Rheumatology, your response to different medications, existing and potential side effects, and your insurance coverage.
Every case is a bit different, but physicians usually try to keep their patient on a rheumatoid arthritis medication for three months before moving on to something elsethis gives them enough time to see if the medication is effective. We want to give the drug three months before we say its a fail, Dr. Singh says. But it should kick in much earlier than three months. However, if your condition is severe, your doctor may decide to change your medication before that three-month mark.
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What Are Rheumatoid Arthritis Causes And Risk Factors
The cause of rheumatoid arthritis is unknown. Even though infectious agents such as viruses, bacteria, and fungi have long been suspected, none has been proven as the cause. The cause of rheumatoid arthritis is a very active area of worldwide research. It is believed that the tendency to develop rheumatoid arthritis may be genetically inherited . Certain genes have been identified that increase the risk for rheumatoid arthritis. It is also suspected that certain infections or factors in the environment might trigger the activation of the immune system in susceptible individuals. This misdirected immune system then attacks the body’s own tissues. This leads to inflammation in the joints and sometimes in various organs of the body, such as the lungs or eyes.
It is not known what triggers the onset of rheumatoid arthritis. Regardless of the exact trigger, the result is an immune system that is geared up to promote inflammation in the joints and occasionally other tissues of the body. Immune cells, called lymphocytes, are activated and chemical messengers are expressed in the inflamed areas.
Gut bacteria, smoking, and gum disease
Environmental factors also seem to play some role in causing rheumatoid arthritis. For example, scientists have reported that smoking tobacco, exposure to silica minerals, and chronic periodontal disease all increase the risk of developing rheumatoid arthritis.
Understand that many forms of joint disease mimic rheumatoid arthritis.
How Do I Take Methotrexate
Methotrexate is typically taken once a week for RA. It is available as both a tablet you take by mouth and as an injection. With the tablets, most people start with one 7.5 mg dose once a week, but your provider may recommend up to a maximum dose of 25 mg once a week depending on how you respond. To reduce the risk of side effects, they may ask you to split the dose into smaller doses that you take throughout the day of the week youre scheduled to take your medication.
If youre using the injection, thats once a week, too. Youll inject the medication either into your muscle or right under your skin, depending on what your provider recommends. The injection is available as either an auto-injector or as a vial. You can find instructions on how to use Rasuvo from the manufacturer here.
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Living With Rheumatoid Arthritis
Rheumatoid arthritis is a lifelong disease. When its treated, it may go away for a little while, but it usually comes back. Its important to see your doctor as soon as symptoms begin. The earlier you start treatment, the better your outcome. Some of the damage from RA is irreversible, so finding the disease and treating it early is very important.
If left untreated, RA can cause other health problems. Your hands may become bent or twisted. Other joints can become deformed. Inflammation will affect your cartilage and bones. Lung and heart problems also can occur. Talk to your doctor if you notice any new symptoms or problems.
Joint Surgery For Treating Rheumatoid Arthritis: A Last Resort
Joint surgery is only conducted after careful consideration, and can help reduce pain, improve joint function, and improve your quality of life.
A surgeon may operate to:
- Clean out inflammation-causing bone and cartilage fragments from the joint, fix tears in soft tissues around joints, or repair damaged cartilage and ligaments
- Remove some or all of the inflamed joint lining
- Fuse a joint so that it no longer bends and is properly aligned and stabilized
- Replace a joint , particularly of the ankles, shoulders, wrists, and elbows, with an artificial one made of plastic, ceramic, or metal
- Remove only a certain section of a damaged and deformed knee joint
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Drugs And Medications For Rheumatoid Arthritis
Rheumatoid arthritis has no known cure, but there are many drugs and medications that can help reduce your inflammation and joint pain. Based on the severity of your rheumatoid arthritis symptoms, your doctor will develop the right medication regimen for you. You will typically exhaust over-the-counter medications before progressing to prescription medications, if necessary.
Below are the rheumatoid arthritis drugs and medications, listed in the order they are commonly used.
There are many drugs and medications that can help reduce your inflammation and joint pain. Photo Source: 123RF.com.
What Are The Pros And Cons Of Non
NSAID painkillers can relieve pain in the joints. Examples of these drugs include:
- celecoxib
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.
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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.
How Does Methotrexate Work To Treat Rheumatoid Arthritis
Methotrexate belongs to a group of medications known as nonbiologic DMARDs . Examples of other nonbiologic DMARDs used to treat RA include , , and .
We dont know exactly how methotrexate works to treat RA yet, but researchers agree that it has an effect on the immune system. Methotrexate is thought to prevent your body from mounting immune and inflammatory responses. One way researchers think it does this is by blocking the effects of folic acid, a chemical that supports the production of new cells. Methotrexate may also ramp up processes in your body that counteract inflammation.
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What Other Risk Factors May Increase Your Likelihood Of Experiencing Ra
* Gender: Women are much more likely to suffer from this autoimmune disorder.* Weight: Overweight individuals are more prone to developing RA.* Smoking: If you smoke, you are more likely to develop RA, and if you develop it, your symptoms may be more pronounced than those who do not smoke.* Age: RA is more likely to hit you in middle age * Environment: Certain environmental exposures have been found to elevate your risk of RA, including exposure to asbestos and silica.
An Overview Of Rheumatoid Arthritis
The goal of treatment is to achieve remission in order to halt the progression of joint damage, maintain mobility, minimize pain, and increase your overall quality of life.
Rheumatoid Arthritis Healthcare Provider Discussion Guide
Get our printable guide for your next healthcare provider’s appointment to help you ask the right questions.
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Who Has A Higher Risk Of Complications
Stomach ulcers or bleeding are more likely to occur in people who
- are over 65 years old,
- have other serious diseases, especially gastrointestinal conditions like or ulcerative colitis,
- have already had gastritis , a stomach ulcer or stomach bleeding,
- have an infection with Helicobacter pylori ,
- drink a lot of alcohol,
- take blood-thinning heart medicines, for example anticoagulants like warfarin or acetylsalicylic acid,
- take a selective serotonin reuptake inhibitor antidepressant,
- take corticosteroids , or
- take several anti-inflammatory painkillers at the same time.
NSAIDs can sometimes be a problem for people who have kidney disease too.
Rheumatoid Arthritis Drugs: Steroids
They are strong anti-inflammatory drugs that can also block other immune responses. Several man-made steroids calls corticosteroids help relieve RA symptoms and may stop or slow joint damage. You receive these RA drugs by pill or as a shot.
Because of the risk of side effects, it is generally recommended that you use these RA drugs only for brief periods for example, when your disease flares up or until DMARDs are fully effective. If your side effects are severe, don’t stop taking the drug suddenly. Talk first with your doctor about what to do.
Examples of corticosteroids:
|
⢠Skipped or irregular periods |
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Nutritional Supplements And Dietary Changes
There’s no strong evidence to suggest that specific dietary changes can improve rheumatoid arthritis, although some people with rheumatoid arthritis feel their symptoms get worse after they have eaten certain foods.
If you think this may be the case for you, it may be useful to try avoiding problematic foods for a few weeks to see if your symptoms improve.
But it’s important to ensure your overall diet is still healthy and balanced. A Mediterranean-style diet, which is based on vegetables, fruits, legumes, nuts, beans, cereals, grains, fish and unsaturated fats such as olive oil, is recommended.
There’s also little evidence supporting the use of supplements in rheumatoid arthritis, although some can be useful in preventing side effects of medicines you may be taking.
For example, calcium and vitamin D supplements may help prevent osteoporosis if you’re taking steroids, and folic acid supplements may help prevent some of the side effects of methotrexate.
There’s some evidence to suggest that taking fish oil supplements may help reduce joint pain and stiffness caused by rheumatoid arthritis.
Further information
- National Rheumatoid Arthritis Society : diet and rheumatoid arthritis
Page last reviewed: 28 August 2019 Next review due: 28 August 2022
Methotrexate For Rheumatoid Arthritis: Is It Safe And How Does It Work
Methotrexate is a medication thats often used to treat rheumatoid arthritis , which can cause symptoms like red, painful, and swollen joints. If youve heard of methotrexate before, you probably already know its a medication thats taken long term to help lessen the symptoms of RA. But what about side effects? And how does it compare to other medications? Heres what you should know about this popular medication and why its still considered to be the first choice among rheumatoid arthritis treatments.
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Significance Of The Study
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Rheumatoid arthritis not only affects the joints but can also affect internal organs, thus causing permanent disability in many instances. Currently, there is no cure for this autoimmune disease, rather, symptoms are addressed on an individual basis. Here, we succinctly summarize the classic and current treatment options available for the management of patients suffering from this complex disease.
Is Methotrexate Safe If Im Pregnant Or Planning To Be
Methotrexate can cause birth defects. It can also increase the risk of infertility in men who take it. If you arent taking methotrexate yet and are planning to be pregnant, let your doctor know. They will likely recommend that you hold off on starting methotrexate. However, if you are already taking it, you may be asked to stop and wait 1 to 3 months before trying to conceive.
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Dosage And Response To Methotrexate
Many studies have tried to explain and identify indicators of a good response to MTX therapy. From the pharmacological point of view, MTX is an antifolate prodrug, metabolized by polyglutamate synthetase into MTX polyglutamates : this leads to the addition of 27 glutamic residues to the parent drug. These MTXPGs are metabolites which are produced in different forms . Dependent on the number of residues short- or long-chain MTXPGs arise, and this may have an influence on clinical efficacy and tolerability. Analysing the accumulation of different MTXPGs in erythrocytes in correlation to the effect of switching from oral to parenteral MTX in 10 RA patients with insufficiently controlled disease activity showed an increase of MTXPGs . The authors hypothesized that this accumulation of long-chain MTXPGs may be the reason for an increased efficacy of MTX. Similar results were reported in patients with JIA the subcutaneous route of administration was also associated with higher proportions of intracellular long-chain MTXPG . Since a study on dose escalation of oral MTX in patients with RA also showed a selective distribution toward intracellular long-chain MTXPGs it appears that the selective emergence of these active metabolites may be mainly a function of dose intensity.
Taken together, these interesting results should lead to further studies on the subject.
What Is The Goal Of Rheumatoid Arthritis Treatment
In treating rheumatoid arthritis, the American College of Rheumatology recommends a treat-to-target approach, where the physician frequently evaluates the patients disease status with the goal of getting them to a target of low disease activity or even remission, meaning extremely low or nonexistent disease activity. Basically, as few symptoms as possible.
In the past, rheumatoid arthritis treatment options were fairly limited, but now there are way more drugs to try, which often makes it easier to find something thats effective, Namrata Singh, M.D., an assistant professor of medicine in the division of rheumatology at the University of Washington School of Medicine, tells SELF. If you or your doctor feel like one treatment isnt working, theres usually another option to try. The skys the limit, Dr. Singh says.
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What Is Rheumatoid Arthritis 123
Rheumatoid arthritis is an autoimmune disease where the immune system attacks body tissues. It primarily affects joints, but it can also cause inflammation of organs, such as the lungs, eyes, skin, and heart. Patients may experience periods of increased symptoms which alternate with periods of fewer or no symptoms. It affects about 1 % of the worldwide population and it is estimated that about 75 % of patients are women. There is no cure for rheumatoid arthritis, but medications can stop the progression of the disease and ease symptoms.
Prediction Of Early Ra
A patient with inflammatory arthritis may pass several stages from the onset of arthritis to a specific form of rheumatic diseases such as RA . The first phase is the period leading up to the onset of arthritis .The second is the period during which persistence or remission is determined. The third and the fourth phases are the evolution into specific form of inflammatory arthritis and the outcome/severity of that arthritis. In some patients, these four phases follow in rapid sequences whereas in other patients the time course may prolong and continue for several months or years. Different genetic backgrounds and environmental factors or treatment can affect the various evolutionary phases of arthritis and alter the natural history of initial inflammatory arthritis .
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Does Acetaminophen Help In Rheumatoid Arthritis
The painkiller acetaminophen only has a weak anti-inflammatory effect. Research has shown that it hardly helps in the treatment of rheumatoid arthritis, and clearly relieves the pain less effectively than NSAIDs do.
If you take acetaminophen anyway, it’s important to use it correctly. Higher doses can lead to liver and kidney damage. So adults shouldn’t take more than 4 grams per day according to the package insert. This is the amount in, for example, 8 tablets containing 500 milligrams of acetaminophen each. Waiting at least six hours between two doses is also recommended. So two 500 mg tablets of acetaminophen every six hours over one day would be the maximum allowed amount.