What is the most effective medicine for rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory disorder that affects the joints. But in some people, RA also damages the skin, eyes, lungs, heart and blood vessels. In fact, about 40 percent of people who suffer from rheumatoid arthritis also experience signs and symptoms beyond the joints.

Although there is no cure for RA, there is a range of effective medications and therapies that help many you manage your condition.

Medications to treat rheumatoid arthritis

After evaluating the severity of your symptoms and how long you’ve had RA, your doctor may recommend one of the following medications:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) – Nonprescription NSAIDs such as Advil®, Motrin® IB and Aleve® can relieve pain and reduce inflammation. Stronger NSAIDs are available by prescription.
• Steroids – Corticosteroid medications, such as prednisone, can reduce inflammation, and help relieve pain and slow joint damage. You may be prescribed a corticosteroid to relieve acute symptoms, with the goal of tapering off the medication.
• Disease-modifying anti-rheumatic drugs (DMARDs) –These drugs can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage.
• Biologic agents –Biologic drugs target parts of the immune system that trigger inflammation that cause joint and tissue damage.

Treating rheumatoid arthritis with physical therapy

Physical or occupational therapy helps many RA patients improve joint flexibility. During these sessions, you’ll learn exercises to help keep your joints flexible, and can discover ways to perform daily tasks to ease joint pressure. At Pomona Valley Health Centers, physical therapy is part of our complete offering of sports medicine in Pomona Valley.

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If you or a loved one is suffering from rheumatoid arthritis or a sports-related injury, the caring team at PVHC is here for you. Comprised of dedicated, experienced doctors, physician assistants, nurse practitioners and nurses, the PVHC pros are ready to address your every medical need. From family medicine and women’s health to sports medicine and urgent care, the support you need is close to home.

Schedule an appointment at a PVHC location near you. For Claremont, Chino Hills or Pomona, call 909-630-7829 or click here to use our online form.

If you suspect you may have rheumatoid arthritis (RA)—or your doctor has recently diagnosed you—then you’re probably already experiencing the classic symptoms of painful, achy, and swollen joints, especially first thing in the morning or after a long day sitting at work.

Unlike other types of arthritis that can be brought on by too much activity, rheumatoid arthritis symptoms tend to happen when you’ve been at rest, not using your joints. Maybe you wake up in the morning and feel stiff. Or maybe you get out of the car after a long trip and find your body will barely move. The discomfort in your joints is the result of an overactive immune system that mistakenly attacks the tissue that lines your joints. The result is pain and inflammation and, over time, damage to the joints that can lead to deformity and disability. You may not know anyone else with the disease, but if you have rheumatoid arthritis, you’re in good company: RA is the second most common type of arthritis, affecting 1.3 million Americans.

The good news about rheumatoid arthritis is that there are many different treatment options. “When someone comes in with rheumatoid arthritis, I tell them that I can get them feeling better and halt the progression of their disease,” says Rebecca Blank, M.D., Ph.D., a rheumatologist at NYU Langone Health in New York City. The question is, which treatments work best and which ones are safest? Start with these joint-saving options.

What Drugs Are Used to Treat Rheumatoid Arthritis?

The RA medications you’ll wind up on will depend on your symptoms and disease severity. To help lessen your pain and inflammation, your rheumatologist (that’s the type of specialist you see for RA) may initially suggest over-the-counter or prescription non-steroidal anti-inflammatories (think ibuprofen or naproxen) or a short course of corticosteroids. But the ultimate goal is to stop or slow the progression of the disease, preventing potentially debilitating cartilage and bone damage. For that, your physician will likely start with disease-modifying anti-rheumatic drugs (DMARDs). These medications slow down your overactive immune system, so it doesn't attack the tissue lining your joints.

Which medication specifically your doc chooses depends on your disease severity. In RA, the goal is to match the strength of medication to the degree of inflammation in the patient's body. “If someone has low disease activity, we may offer hydroxychloroquine, which is the least immunosuppressive of the bunch,” says Saika Sharmeen, M.D., assistant professor in the division of rheumatology at Stony Brook Medicine in Stony Brook, NY.

For more moderate-to-severe diseases, the starting point is typically methotrexate. If that isn’t helping, your doctor may switch to biologic drugs. Biologics are monoclonal antibodies that target cells called cytokines, which are involved in the immune response that causes inflammation. They include tumor necrosis factor inhibitors (TNF-inhibitors), B-cell inhibitors, T-cell inhibitors, and different types of Interleukin inhibitors. “When DMARDs aren’t enough, we add on a biologic, or something called triple therapy, which is three oral medications at one time,” says Dr. Sharmeen.

Rheumatoid Arthritis Drugs With The Least Side Effects

First, let’s get this out of the way: All drugs come with side effects. Your physician will balance your quality of life with the severity of the disease when choosing the right med for you. The RA drug with the least side effects is hydroxychloroquine (Plaquenil). “We don’t consider it immunosuppressive, and it doesn’t cause elevated liver markers or kidney issues like some of the other drugs,” says Dr. Sharmeen. However, that doesn’t mean it’s without side effects at all. “We have patients monitored by an ophthalmologist for retinal toxicity, which can happen over 10 years,” she says.

Methotrexate, considered a first-line drug for moderate RA, is also well tolerated. But it can cause elevated liver enzymes. When choosing between the two, your doctor will consider your lifestyle. For example, if you drink alcohol, methotrexate may not be your best option.

Which Is Safer: Methotrexate or Leflunomide?

These two DMARDs have a very similar safety profile, says Dr. Sharmeen. Yet, methotrexate is considered a first-line drug, while leflunomide is a second-line medication. Why? “Methotrexate is tolerated better and works a little better for rheumatoid arthritis,” she says. Research has shown more improvement when methotrexate is the initial medication. A study published in Rheumatology showed that improvements from methotrexate were more significant after one year than those taking leflunomide for their RA.

Are Biologics Safer Than Methotrexate?

Oral drugs such as methotrexate can cause non-serious immediate side effects such as nausea and GI issues. They can also cause hair loss. "With biologics, we don’t see those immediate side effects, but they have a potential for more serious side effects—even though we don’t see them often,” says Dr. Sharmeen. The most common biologics side effect is a skin reaction at the injection site. The most severe side effects are the potential for infection, including the reactivation of conditions such as tuberculosis and hepatitis B, increased risk of certain cancers, and liver damage.

Talk to Your Doctor About RA Treatments

When taking meds, you should discuss a few things with your rheumatologist. For starters, tell your doctor if you’re planning to start a family shortly (whether you’re a woman or a man). “With some of these medications, you want to be off it for about three months before trying to get pregnant, or trying to get your partner pregnant,” says Dr. Blank.

On the other hand, the DMARDs sulfasalazine and hydroxychloroquine are considered safe for pregnancy, so if you’re planning to get pregnant, your doctor may start you on one of those. Theoretically, you can be on some TNF inhibitor biologic drugs until your third trimester, says Dr. Sharmeen. “But the only one that’s safe is Cimzia,” she says.

You also want to talk about your lifestyle. For example, if you drink alcohol your doctor will avoid a drug that affects your liver enzymes. And tell your physician if you tend to get a lot of recurrent infections, upper respiratory infections, or are around young children who may pass along infections—your doctor may choose a less immunosuppressant drug if your situation makes you more vulnerable to infections. “These are all important things for your doctor to know to find the right for you,” says Dr. Sharmeen.

• Arthritis Stats: Arthritis Foundation. (2019.) “Arthritis by the Numbers.” https://www.arthritis.org/getmedia/e1256607-fa87-4593-aa8a-8db4f291072a/2019-abtn-final-march-2019.pdf
• Methotrexate vs. Leflunomide: American Family Physician. (2003.) “Is Leflunomide as Safe and Effective in the Treatment of Rheumatoid Arthritis as Other DMARDs?” https://www.aafp.org/afp/2003/0901/p849.html
• Biologics and RA: Medicine. (2021.) “Determinants of First-Line Biological Treatment in Patients with Rheumatoid Arthritis.” https://journals.lww.com/md-journal/Fulltext/2021/05140/Determinants_of_first_line_biological_treatment_in.85.aspx
• RA Meds and Pregnancy: Rheumatology International. (2011.) “The Treatment of Rheumatoid Arthritis During Pregnancy.” https://pubmed.ncbi.nlm.nih.gov/21120498/

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