Rheumatoid arthritis treatment with Disease-Modifying Anti-Rheumatic Drugs (DMARDs) is often used when non-steroidal anti-inflammatory drugs (NSAIDs) are not enough to make you comfortable, or if your doctor is concerned that you may develop permanent damage to your joints.
These rheumatoid arthritis treatments work in different ways to slow down or stop the disease process. Because they work in different ways they have different risks and different side effects.
DMARDs most Commonly used to Treat RA
Some of the most commonly used DMARDs are methotrexate, hydroxychloroquine, and sulfasalazine.
They can be effective for treating RA because they interrupt different parts of the complicated chain of events that leads to joint damage.
Methotrexate has been shown to have anti-inflammatory and immunosuppressant effects but the way it works is very complex and not well understood.
Its major effects appear to be related to the suppression of folic acid metabolism.
It also seems to inhibit the production of purine and pyrimidine and stimulate the release of adenosine which give it anti-inflammatory influences.
Ibuprofen is a commonly used NSAID that can be very effective for pain but it does little to protect against joint damage.
Image thanks to Derrick Coetzee via Wikimedia Commons
Methotrexate will often take 4-6 weeks to start having an effect. The most severe side effects are related to liver damage, inflammation within your lungs, and inhibiting your production of different blood cells. These side effects are rare but your doctor will monitor you closely when you are taking methotrexate.
Hydroxychloroquine was originally developed as a treatment for malaria. Exactly how it works to help treat RA is unknown.
It seems to change the way your antibodies recognize antigens and it may suppress your immune system in other ways as well.
Rare but Serious Complication
It may take from two to several months to have an effect. The most serious side effects of hydroxychloroquine are related to your eyes and may cause blindness.
Fortunately, this is a very rare complication of treatment but you should make sure that you are getting regular eye exams to prevent permanent damage.
Sulfasalazine is another DMARD whose precise mechanism of action or how it works is unknown. However, it has been shown to reduce pain and slow the progression of joint damage on x-rays.
Generally Well Tolerated
It is generally well tolerated and the most common side effects are mild. It may cause allergic reactions in people who are allergic to sulfa.
Complaints of stomach upset are common and can be treated by taking your medication with meals or by using specially coated pills to protect your stomach.
Your doctor will still want to monitor your routine labs such as blood cell count and liver function tests.
Triple Therapy with DMARDs
For many people one or more of the DMARDs may not be effective or they may not be effective enough to make you comfortable and stop the progression of joint damage.
Most commonly methotrexate is the first line of treatment and then after several months of monitoring your symptoms and any side effects or adverse reactions you may be having your doctor might add another DMARD to your regimen. He may also stop one and start another if you are not tolerating the first one very well.
Everybody is an experiment of One
If after trying one or more of these drugs separately and understanding how well you are tolerating them your doctor may start combining them to try and gain additional benefits.
Many people find that they can tolerate all three drugs, methotrexate, hydroxychloroquine, and sulfasalazine, without severe adverse effects and "Triple Therapy" is often adequate for controlling the disease.