Combination Therapy for Rheumatoid Arthritis

Combination Therapy for Rheumatoid Arthritis

         Combination Therapy for Rheumatoid Arthritis

There is no drug that can cure rheumatoid arthritis (RA), but there are many drugs to treat it. Doctors are discovering that the best way to ease swelling, improve movement, and reduce damage caused by RA is to treat it early and aggressively. This could mean taking more than one RA drug at the same time. This is called combination therapy.
Recent studies show that using combination therapy for newly diagnosed and active RA may be better than using one drug alone. In one study, doctors found that for people with early, active, and moderate to severe RA, using two drugs was more likely to control RA symptoms and prevent joint damage than using only one drug.
If you have early and active RA, combination therapy may be the best way to get your RA under control and stop your symptoms. This is called putting your disease into remission.

Drugs Used in Combination Therapy

There are four basic types of drugs used to treat RA:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to relieve pain and swelling quickly.
  
• Corticosteroids are quick-acting and powerful drugs that block and decrease swelling (inflammation) in RA.
  
• Disease-modifying anti-rheumatic drugs (DMARDs) are stronger than NSAIDs and are used to slow down the progression of RA. They take a few weeks to start working.
  
• Biologic response modifiers (biologic DMARDs) are drugs that may be used when regular DMARDs are not working. Some of these drugs are also called anti-TNF drugs because they block tumor necrosis factor (TNF), a substance in your blood that causes inflammation and joint damage.
  

NSAIDs and steroids may be combined with any type of RA treatment to get a quick response. When doctors talk about combination therapy, they are talking about the best combination of DMARDs or biologic DMARDs for your long-term treatment of RA.

Finding the Right Level of Combination Therapy

Your RA will respond differently than other people’s RA. No combination therapy is right for everyone. If your RA is mild, you may start out with only one drug. If your doctor decides to use combination therapy, one of the drugs will probably be the DMARD methotrexate.
Methotrexate is used as the first drug in combination treatment because it works well in many people. It also causes fewer side effects than many other RA drugs. Methotrexate is the DMARD that most people with RA stay on the longest.
The American College of Rheumatology has these guidelines for combination therapy (Source: ACR):

• Two-drug DMARD therapy may be used if you have moderate to severe RA. The recommended combination is methotrexate and hydroxychloroquine. Hydroxychloroquine is a drug that also works for malaria. Doctors are not sure how it works in RA.
  
• Three-drug DMARD therapy may be used if your RA is moderate to severe and your doctor is worried about long-term damage from RA. A common combination is methotrexate, hydroxychloroquine, and sulfasalazine. Sulfasalazine is not as strong as methotrexate but seems to work well when combined with methotrexate.
  
• Methotrexate and an anti-TNF drug may be used if you have severe RA and have never been on a DMARD before. Anti-TNF drugs include etanercept, infliximab, certolizumab, golimumab and adalimumab. Anti-TNF drugs need to be given by injection or infusion (through an IV).
  

Side Effects and Long-Term Use

All RA drugs have side effects. Side effects from DMARDs may include liver damage, lung damage, and decreased resistance to infection. These drugs may not be safe during pregnancy.
Using more than one drug in combination therapy does not seem to cause more side effects, but doctors are still studying the long-term effects. If your doctor prescribes a combination therapy for you, see him or her for frequent follow-up visits. You may need to have blood tests to make sure you are not having a reaction to the drugs. Talk with your doctor about all the risks and benefits of combination therapy for RA.

6 Tips to Ease Your RA Pain

6 Tips to Ease Your RA Pain

6 Tips to Ease Your RA Pain

 Many people with rheumatoid arthritis believe there's nothing they can do to ease their pain and stiffness, but they're wrong.

Give the following self-care steps a try :

• Lose weight. Every extra pound you carry translates to added stress and pain to your knees and hips. Too much weight also increases your risk for gout.
  
• Get moving. Exercise helps lessen pain, helps with weight loss, increases range of movement, reduces fatigue, and helps you feel better overall, according to the Arthritis Foundation. Your doctor, a physical therapist, or other health care professional can teach you beneficial range-of-motion and strengthening exercises.
  
• Protect your joints. Avoid excess stress on joints by learning how to do chores and activities in less stressful ways. An occupational therapist can show you how to manage everyday tasks with less strain and pain.
  
• Learn to pace yourself. Spread out difficult activities over a week's time instead of trying to do them all in one day and then suffering for several days afterward.
  
• Stretch. Stretching is a simple way to keep joints and muscles flexible. It relieves stress and can help you maintain your daily activities with less stiffness.
  
• Adjust your attitude. Try to maintain a positive state of mind about your condition and how it affects your life.
  

Facts About Biologics for Rheumatoid Arthritis (RA)

Facts About Biologics for Rheumatoid Arthritis (RA)

Facts About Biologics for Rheumatoid Arthritis (RA)

Over the last decade, significant progress in the treatment of RA has been made because of drugs known as biologics. Biologic drugs are made from human genes inside non-human cells. Your doctor may suggest biologics if you respond poorly to other treatments. Here's what you should know about these exciting advancements and how they may be able to improve your RA and your quality of life.

How Biologics Work

How Biologics Work

RA is an autoimmune disease. This means your body mistakes some of its own tissues as foreign substances and attacks itself. In RA, when your immune system attacks your joint tissue, it causes inflammation that damages your joints and makes them painful. Biologics are designed to inhibit the cells that cause your immune system to go into this mistaken overdrive.

How Biologics Are Given

How Biologics Are Given

Biologics are not yet available in pill form. Because the biologics are made of such large protein molecules, your body cannot absorb them if you swallow them in a pill or liquid form. Biologics need to be introduced into the body slowly. The only biologics that have been approved for RA by the U.S. Food and Drug Administration must be injected or given intravenously. In the future, you may be able to take biologics by mouth: Oral biologics for RA made from small protein molecules are in development.

Who Can Benefit Most from Biologics

Who Can Benefit Most from Biologics

Your doctor may suggest biologics if your RA is moderate to severe and has not responded to traditional treatments. You may be given biologics alone or with other medications to increase their effectiveness and decrease their side effects. Biologics have been shown to be effective in two out of three people who use them.

When You'll Feel the Results

When You'll Feel the Results

Studies show that RA patients who are given biologics generally show improvement in about 4 to 6 weeks. However, many patients report less joint swelling and discomfort soon after their first or second injection. How often your injections are scheduled depends on which biologic you're given. Some are given daily; others, every few weeks.

Common Side Effects

Common Side Effects

Most biologics are well-tolerated. About a third of people given biologics experience a skin reaction at the site of the injection. This could be a burning or itching sensation or a rash that will go away on its own in a week or two. A more serious side effect is your increased risk of infection, including tuberculosis, when taking biologics. You can work with your doctor to recognize the signs and symptoms of infection.

The Cost of Biologics

The Cost of Biologics

Biologics are expensive, between $12,000 and $30,000 a year. Because they are produced from live organisms, the materials needed to make them are expensive. The manufacturing process is more complicated than that for traditional drugs made from chemicals. Their cost also reflects the cost of research and development. Generic versions, which could cost less, are not yet available.

Biologics and Cancer Risk

Biologics and Cancer Risk

There is some concern about long-term, serious risks from taking biologics, including some forms of cancer, but the research is inconclusive. Because of the relative newness of biologics, any long-term risks are not yet known. It's difficult to draw hard and fast conclusions from the small amount of existing research. Always weigh the benefits and the risks of all treatment options through a careful discussion with your rheumatologist.