Rheumatoid Arthritis: Finding the Right Medicine for You

Topic Overview

About rheumatoid arthritis medicines

When you learn that you have rheumatoid arthritis (RA), starting treatment right away helps preserve your joints. Medicine improves RA pain, joint swelling, and disability.

There are many RA medicines that can help control the disease. Most are called disease-modifying anti-rheumatic drugs, or DMARDs. Different DMARDs work on different levels of the immune system. They all slow or stop inflammation over the long-term. This is the key to controlling RA.

• All DMARDs have risks and possible side effects, such as serious infection.
• Some DMARDs have been in use for many years. Others are much newer. The newer "biologic" DMARDs are the ones you see in ads. They cost much more than the older DMARDs, tens of thousands of dollars per year.
• There is no older DMARD or newer biologic DMARD that works best for everyone.

Like many people with RA, you may have to keep trying before you find which DMARD, or mix of medicines, controls your RA. If a medicine makes you feel sick or doesn't work for you after a few months, your doctor will change your medicine.

Which DMARD to use?

RA experts have created guidelines for what types of DMARD to try and when. Guidelines help your doctor and you decide how to treat your RA. Generally, the experts say it is best to save biologic medicine for severe RA or when nothing else has worked.

• Unless your RA is severe, one of the older DMARDs is the first step in treating RA. Methotrexate is often the first choice. Other DMARDs your doctor may consider include hydroxychloroquine, leflunomide, and sulfasalazine.
• Taking a DMARD for 3 to 6 months is usually enough to tell if it can help you. If it doesn't work very well, you switch to a different DMARD. Or your doctor may add one or two other DMARD medicines.
• Often, the best choice for treating RA is a combination of medicines. Taking more than one DMARD usually relieves RA symptoms better than one DMARD does by itself. And it can make it possible to take lower doses of each DMARD. This means you may have fewer problems with side effects.

NSAID and corticosteroid medicine. Along with a DMARD, you may also start treatment with a corticosteroid or nonsteroidal anti-inflammatory drug (NSAID), or both. These medicines can be used as a "bridge" to help control symptoms while you wait to see if a DMARD works for you. They can also help later on when you need extra symptom control.

NSAIDs can damage your kidneys and stomach, and corticosteroid medicines can be hard on your body. So they aren't usually used for a long time like DMARDs are. If you use an NSAID, be sure your doctor knows you're taking it.

Be safe with medicines. Read and follow all instructions on the label.

Working and deciding with your doctor

Your doctor is the expert about RA medicines. You are the expert about how your body feels and what you prefer. Together, you are a decision-making team. So work with your doctor and be sure you know the answers to these questions before you try a new treatment:

• Why does my doctor want me to try this medicine?
• Are there other choices we haven't talked about yet?
• What kind of risk am I comfortable with? Medicine side effects and risks are a serious problem for some people. You won't know how a medicine will affect you until you try it. But your doctor can help you think through possible risks as they apply to you.
• What can I afford? The cost of some biologic medicines is thousands of dollars per month. This can make even co-pays expensive. Check with your insurance company to find out how much certain medicines will cost you.