Rheumatoid Arthritis Drugs

Rheumatoid arthritis (RA) is a condition in which the immune system attacks the lining of the joints. The disease affects 1% population between 20 and 50 years. It may first become evident as pain in the hand or foot joints but can also affect other joints. Other symptoms include fatigue, dry eyes, dry mouth, fever and/or chills (flu-like symptoms).

In treating RA, not only today's pain must be considered, but also the risk of future joint damage. The inflammation can eat away at the joint causing irreversible damage. Unlike osteoarthritis, which affects only the joint and progresses slowly over many years, joint damage with RA may become evident within 2 years.

Typically RA is treated with a disease modifying anti-rheumatic drug (DMARD), which may take 6 weeks to 6 months to begin to work. To help control symptoms in the meantime, your doctor may offer the following:

• an oral anti-inflammatory medication;
• a cortisone injection;
• pain relievers, ice to reduce inflammation and/or hand splints.

The most common DMARD used in mild RA is hydroxychloroquine, which is well tolerated. Alternative DMARDs for mild RA include sulfasalazine and minocyline.

For moderate RA, the number one DMARD is once-weekly oral methotrexate. Methotrexate is well tolerated by the majority of people with fine tuning although some people may required injections to provide maximum benefit. DMARDs may also be used in combination if required.

Newer agents called biological response modifiers have recently been approved for RA. These agents are very expensive and are generally reserved for patients who do not obtain relief with standard DMARD combinations.