Rheumatoid Arthritis

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The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

September is arthritis awareness month. Last time we talked about the very common osteoarthritis. This time we will talk about the less common but sometimes more serious rheumatoid arthritis. But remember, arthritis has more than 100 different forms.

Rheumatoid arthritis (RA) is an autoimmune disease condition in which the body’s own immune system attacks the lining of the joints. The first thing someone might notice is pain in the hand or foot joints but can also affect other joints. Other symptoms a person might experience include fatigue, dry eyes, dry mouth, fever and/or chills. RA can cause the immune system to attack other internal organs like the eyes, lungs and heart.

How do I know if I might have RA? Symptoms can include: Pain, swelling, tenderness, heat or redness in a joint. The hands and feet are the joints most often affected. Unlike osteoarthritis, in rheumatoid arthritis morning stiffness usually lasts longer than 30 minutes. The pain of RA can be in 3 or more joints at the same time. (Often osteoarthritis effects only one joint like a knee.) The pain from RA can last all night long. The pain from RA can be symmetrical on both sides of the body. That means, for example, both your wrist are sore. RA can also cause non-joints symptoms like fatigue, fever and weight loss.

When a doctor is thinking about how to treat a patient’s RA, the doctor has to think about more than just how to relieve the pain. The doctor has to consider how to protect the joints from the inflammation which can eat away at the joints. Unlike osteoarthritis, which effects only the joint and takes many years to cause damage, in RA the disease attacks other parts of the body, and joint damage can occur within 2 years.

A doctor can start treating the pain of RA with pain relievers like acetaminophen (Tylenol), with or without codeine, or a stronger narcotic like oxycodone. These work within an hour on the pain, but they don’t effect the inflammation at all.

The next step (remember the doctor can skip steps, combine steps, etc, because each patient is unique) is a non-steroidal anti-inflammatory drug (NSAID). NSAID’s are drugs like ASA, ibuprofen and naproxen. They work well for pain and they reduce the inflammation that can cause the joint damage. NSAID’s can take 2-4 weeks of constant use to become fully effective. The problem with older NSAID’s like naproxen is that they can be hard on the stomach and cause problems like ulcers. So newer NSAID’s like celecoxib, and rofecoxib were developed that still reduce pain and inflammation, but are easier on the stomach.

Remember that the above medications don’t really do anything about the problem that the body’s own immune system is attacking the joints. This is done by medications called DMARD’s, disease modifying anti-rheumatic drugs (yes sometimes healthcare seems to have more acronyms than NASA), effect the immune system to stop it from attacking the joints. The most common DMARD in mild RA is hydroxychloroquine and is generally well tolerated. For moderate RA, methotrexate once a week is very common and seems to work very well. Depending on the DMARD, these drugs can take 6 weeks to 6 months to work.

Newer drugs call biologic response modifiers which more selectively block just the inflammation response and not the whole immune system have recently become available. These new medications are very expensive and generally only considered if a patient fails to respond to the standard DMARD combinations. They have names like etanercept (Enbrel), infliximab (Remicade), and anakinra (Keneret).

For more information visit www.arthritis.ca

As always if you have any questions or concerns about these or other products, ask your pharmacist.