Meds for rheumatoid arthritis exist

Dear Dr. Roach: Why doesn’t rheumatoid arthritis have any medicines to help treat it?

Answer: Rheumatoid arthritis is relatively common, but it’s a much less common form of arthritis than osteoarthritis. However, rheumatoid arthritis is much more feared because it can be destructive to the joints. It can also affect other parts of the body besides the joints, especially the heart, lungs, blood vessels and skin.

When I underwent training, I saw many patients with terrible deformities of their hands, but that is much less common now because there are many new and effective treatments for rheumatoid arthritis. It’s important for primary care doctors like me to recognize rheumatoid arthritis early and get our patients to the experts (rheumatologists) as quickly as possible to begin treatment before permanent damage to the joints occurs. Blood testing and X-rays usually confirm the diagnosis.

Early use of drugs to get RA under control (these are often called DMARDs, diseasemodifying antirheumatic drugs) has become the standard of care. Methotrexate is probably the most common drug rheumatologists initially prescribe, but hydroxychloroquine is also frequently used.

Anti-inflammatory drugs, including NSAIDs like ibuprofen as well as steroids like prednisone, are often used at first to get symptoms under control while the DMARDs start working, which may take weeks or months.

There are a wide range of biological therapies that are used in people who do not respond to this treatment. Many of these drugs, whose generic names end in “-mab,” are monoclonal antibodies working against certain cellular triggers for rheumatoid arthritis.

Other synthetic DMARDs work against the Janus kinase enzyme. These drugs end in “-nib.”

The treatment of RA changes so quickly that an expert who does this every day is by far the best choice when available.