Treatment aim 2
Treatment aim 2 - to prevent joint damage as much as possible
Disease-modifying drugs
There are a number of drugs called 'disease-modifying antirheumatic drugs' (DMARDs). These are drugs that ease symptoms but also reduce the damaging effect of the disease on the joints. They work by blocking the effects of chemicals involved in causing joint inflammation. They include: sulfasalazine, methotrexate, gold injections, gold tablets, penicillamine, leflunomide and hydroxychloroquine. It is these drugs which have improved the outlook (prognosis) in recent years for many people with RA.
It is usual to start a DMARD as soon as possible after RA has been diagnosed. This is to try and limit the disease process as much as possible. In general, the earlier you start one, the more effective it is likely to be.
DMARDs have no immediate effect on pains or inflammation. It can take up to 4-6 months before you notice any effect. Therefore, it is important to keep taking a DMARD as prescribed, even if it does not seem to be working at first. After starting a DMARD, many people continue to take an anti-inflammatory tablet or steroid tablets for several weeks until the DMARD starts to work. Once a DMARD is found to help, the dose of the anti-inflammatory tablet or steroid can be reduced or even stopped. It is then usual to take a DMARD indefinitely.
Other DMARDs include azathioprine, cyclosporin, and cyclophosphamide. These are usually reserved for people who do not respond well to the more commonly used DMARDs, due to the risk of serious side-effects.
Each of the DMARDs has different possible side-effects. If one does not suit, a different one may well be fine. Some people try two or three DMARDs before one is found to suit. (Some side-effects can be serious. These are rare, but it is usual to have regular tests - usually blood tests - whilst you take a DMARD. The tests look for possible side-effects before they become serious.)
Newer disease modifying drugs
A new class of drugs which have recently been developed are drugs that modify the effect of TNF-alpha. The chemical TNF-alpha plays an important role in causing inflammation in joints. Blocking the effect of TNF-alpha has been shown to reduce damage to joints, and reduce symptoms. Drugs which modify or block the effect of TNF-alpha include: etanercept, infliximab, adalimumab, and anakinra. They show promise but their long-term benefits are still being evaluated.
One problem with these drugs is that they need to be given by injection. They are also expensive. Recent guidelines state that one may be tried if there has been little success when using standard DMARDs.
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Where to next?
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How does rheumatoid arthritis develop and progress?
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How is rheumatoid arthritis diagnosed?
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Joints and rheumatoid arthritis
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Rheumatoid arthritis treatments
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Some other associated diseases and possible complications
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Treatment aim 1
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Treatment aim 2
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Treatment aim 3 and 4
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What are the symptoms of rheumatoid arthritis?
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What is the outlook (prognosis) for people with rheumatoid arthritis?
