Rheumatoid arthritis is the most common inflammatory form of arthritis, affecting an estimated two million Americans. It is a chronic, systemic and autoimmune disease for which there is no cure. However, there are medications available that can control it and put you in remission.
The key is early diagnosis and aggressive treatment.
This article will discuss some of the commonly used disease modifying antirheumatic drugs (DMARDS). Another article will discuss biologics.
Methotrexate is the “workhorse” of DMARDS. It works by blocking an enzyme called dihydrofolate reductase, in effect preventing the proliferation of inflammatory cells. It can be administered orally, subcutaneously and intravenously. Potential side effects include fatigue the day after taking the medication, nausea, hair loss, mouth ulcers, liver damage, drops in blood counts, particularly white blood cell counts, and lung damage that can occur acutely or chronically. Methotrexate is also a teratogen and can cause significant birth defects.
Hydroxychloroquine (Plaquenil) is a drug that has been used to treat malaria but has some modest effects in the treatment of rheumatoid arthritis. It has an immunomodulatory effect that has not yet been clearly defined. Side effects include skin rashes, particularly if the individual is exposed to the sun, muscle damage, gastrointestinal upset and diarrhea, and damage to the retina of the eyes.
Sulfasalazine (Azulfidine) is a sulfa that has an anti-inflammatory effect. Once metabolized, it breaks down into several components, one of which is 5-aminosalicylic acid. It is used much more in Europe than in the US Side effects include gastrointestinal upset, drops in blood counts, lung inflammation, blood vessel inflammation, lupus, and a life-threatening condition called Stevens-Johnson syndrome. This causes severe ulceration of the gastrointestinal and respiratory systems.
Leflunomide (Arava) is an oral drug that blocks the synthesis of pyrimidines, which play an active role in RA. Side effects include gastrointestinal upset, rash, liver damage, drops in blood counts, immune suppression, and birth defects.
Tetracycline is an antibiotic that also has the effect of blocking enzymes that stimulate inflammation. Tetracyclines also have an inhibitory effect on T cells. Side effects include a photosensitive rash, tooth discoloration, lupus, blood vessel inflammation, and liver damage.
Azathioprine (Imuran) is a potent immunosuppressive drug that blocks purine production. It can cause deep drops in blood counts, liver toxicity, fever, and can be extremely toxic when combined with other medications such as allopurinol.
By now your hair is starting to curl. Remember the other side of the coin, which is that rheumatoid arthritis itself is a serious disease that can shorten lifespan by ten to fifteen years and cause significant disability, disability, and damage to internal organs.