Written by Elea Carey
Medically Reviewed by Nancy Carteron, MD, FACR
For those with rheumatoid arthritis (RA), nonsteroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs) are often the first-line treatment option. NSAIDs help pain by reducing inflammation in your joints. And while they’ve been in use for decades and provide a certain level of comfort, they do nothing to prevent joint damage.
Read on to find out more about these RA medications along with advanced therapies that you may want to consider. Basic RA medications: DMARDs, NSAIDs, and steroids. DMARDs represent a major change in how RA is treated. They suppress your immune system to stop inflammation and actually slow RA’s destruction of joints.
"When I entered my practice in the 1980s, it wasn’t uncommon for new patients to tell me, “I don’t know why I’m here. I know there is nothing you can do.” That picture has changed dramatically in recent years.
– Alan Schenk, MD, rheumatologist at Saddleback Medical Center, Laguna Hills, California
In spite of their benefits, DMARDs come with potential side effects. You shouldn’t get pregnant when you’re taking them because they can cause birth defects or terminate a pregnancy. As well, DMARDs interact with your immune system. You could be more susceptible to infection when you’re taking them. NSAIDs can cause stomach problems, including ulcers, and increase the chance of bleeding disorders because they thin your blood. Less common side effects include impaired kidney function, heart attacks, and strokes. Steroids have been known to cause fatigue and body aches. If you take steroids for more than a few weeks, your body can stop making a hormone called cortisol. When you stop taking the steroid, you might experience side effects because of the lack of cortisol, so tapering steroids (gradually reducing your dose) is extremely important.
These side effects might be one reason you’re considering changing or augmenting your treatment, although Schenk points out that patients should weigh the small risk of side effects against the effects of untreated RA. “On balance, we believe that it’s worth accepting a small amount of risk in exchange for the benefit of controlling and relieving the symptoms of this potentially crippling disease. Avoidance of disease-modifying therapy allows RA to gain the upper hand, leading to progressive damage, deformity, and disability.” For some people, it isn’t the side effects that cause them to consider other treatments. Some find that the standard RA treatment protocol stops working for them. If that’s what’s happened in your case, you might be considering other treatment options.