How do DMARDs work for rheumatoid arthritis?
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, were once the main treatment for rheumatoid arthritis (RA). Treats joint pain and inflammation. It does not prevent joint damage. If these don't work, your rheumatologist may consider giving her a DMARD, a new type of drug.
That has changed in the last 15 to 20 years, Ruderman said. Currently, DMARDs are prescribed as soon as rheumatoid arthritis is diagnosed. why? „We recognize that just treating the symptoms doesn't really cover it. You have to treat the underlying disease. That's what gives you the best long-term results,“ he says. Masu.
Each type of DMARD operates differently. But all of them not only treat symptoms, but also block inflammation and slow the progression of the disease. This minimizes joint damage and complications such as heart disease caused by the inflammation caused by rheumatoid arthritis, Ruderman says.
„Our goal these days is not just to manage symptoms, but to put people into remission if possible, so people are on disease-modifying drugs from the very beginning. And in most cases , it is possible,” Ruderman said.
NSAIDs and corticosteroids are also important parts of treatment plans for rheumatoid arthritis, but they only improve symptoms caused by inflammation. DMARDs are fundamental because they work with the immune system to slow or even stop disease progression.
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Why does DMARD take so long to work?
Because DMARD drugs treat the underlying inflammation, „they don't work overnight,“ Ruderman says. People often see some effects right away, he says, but it usually takes some time to relieve symptoms such as swelling and pain in the joints and morning stiffness.
„Another complicating factor, especially with methotrexate, is that there are dosing issues,“ Ruderman says.
Your rheumatologist will likely start you on a lower dose for about a month. If it's still not effective enough, your doctor may increase your dose. It usually takes about 3 months before you and your doctor can determine whether the medicine is working. Depending on the type of DMARD, it can take up to six months to see maximum effect, he says.
What types of DMARDs are there?
Doctors can choose between traditional DMARDs, which act on the entire immune system to fight inflammation, and biological DMARDs, which target specific proteins involved in the immune response.
DMARD drugs used for RA include:
- azathioprine
- Hydroxychloroquine
- Leflunomide (Arava)
- Methotrexate (Rheumatrex, Trexol)
- Sulfasalazine
- Biological DMARDs known as tumor necrosis factor inhibitors (such as adalimumab (Humira), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), and infliximab (Absola, Infractra, Remicade, Renflexis))
- Biologics called B-cell inhibitors, such as rituximab (Rituxan, Luxience, Truxima)
- Biologics called selective costimulatory modulators, such as abatacept (Orencia)
- Janus kinase inhibitors, baricitinib (Olumiant), tofacitinib (Xeljanz), upadacitinib (Rinvok), etc.
Methotrexate is usually the first drug that DMARD doctors prescribe for RA patients. Hydroxychloroquine, leflunomide, and sulfasalazine are also common treatments.
Ruderman says leflunomide and methotrexate typically take the longest to take effect.
Biological DMARD drugs are faster. “We often expect to see some results in about six weeks, sometimes sooner,” Ruderman says.
Newer kinase inhibitors, such as tofacitinib and upadacitinib, are the fastest-acting, he says. “Typically, you’ll see results within about a month,” he says.
What does successful treatment look like?
The ideal outcome is eventual remission.
„Our goal is to treat patients, especially early on,“ Ruderman said. „It's hard to know for sure, but we have between a 60% and 75% chance that we can actually put people into remission.“ This may require several tries using different drugs. there is.
Ruderman defines remission as the absence of joint swelling, pain, and tenderness. There may be one or two days a week where he doesn't feel well or feels sore in the morning, but this improves quickly. „Most people don't feel like this disease is a problem in their life,“ he says.
Unfortunately, if you've had rheumatoid arthritis for years, you've probably already done a lot of damage, Ruderman says. That's because previous treatments weren't very effective. DMARD cannot undo the past damage caused by his RA. However, they may slow the progression of the disease and prevent further harm to the joints.
How do I know which drug is best for me?
Although rheumatoid arthritis treatment has come a long way, there is no way to predict which drugs will work best for you. You may have to try three or four drugs to find one that works.
„It's amazing that we have so many good drugs and they all work so well,“ Ruderman says. „There's no good way to choose between them.“
How long should I take DMARDs?
„The answer is almost always there,“ Ruderman said. „Rheumatoid arthritis is a lifelong disease, and none of the drugs we have will treat it. They have it under control.“
Once you find something that works, you should be able to use it for up to 15 to 20 years before you need to try something else. Previous studies have shown that completely stopping the drug can cause symptoms to flare up, even if the patient is in remission.
„It's just not worth it,“ Ruderman said. However, once you are in remission, your rheumatologist may be able to reduce your dose slightly or extend the time between doses.