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Rheumatoid arthritis (also known as RA) is a potentially devastating condition for which there is no cure. Worldwide, about one person in one hundred has the disease, but in some populations, such as Native Americans, it is much more common, up to about one in twenty. RA strikes in the prime of life, usually between the ages of 25 and 50, and about 40 percent of people who develop it become permanent disabled.
This form of arthritis most often first attacks the joints of the fingers, and then the neck and feet, although any joint can be affected. Pain at first comes and goes, but generally becomes constant and hard to control.
Most treatments for rheumatoid arthritis cause serious side effects:
- The most basic pain reliever for both rheumatoid arthritis and osteoarthritis is aspirin. It can cause stomach upset. Using too much Aspirin can result in peptic and duodenal ulcers.
- People who do not use Aspirin for arthritis pain relief typically use other NSAID drugs such as ibuprofen (Motrin, Advil), naproxen (Naprosyn, Aleve, Anaprox, Anaprox DS, Naprelan) , and acetaminophen (Tylenol). Although they do not cause side effects in everyone who takes them, digestive upsets of various kinds are common.
- Tetracycline antibiotics are often used when RA is first diagnosed. They keep the white blood cells that damage joints from migrating to other parts of the body. They kill probiotic bacteria in the colon, and they also can cause diarrhea and susceptiblity to urinary tract infection. In rare instances, the tetracycline antibiotic minocycline can cause bluing of the enamel of the teeth.
- Steroid drugs such as Prednisone, methylprednisone, and prednisolone are relatively common in the management of RA. They work by reducing the inflammation generated by the immune system, by making capillaries less permeable so there is less swelling inside joints and less morning stiffness, and by keeping white blood cells from moving from already-inflamed joints to new sites of the disease. Steroids typically have to be discontinued because a variety of side effects including weight gain, dry skin, rashes, glaucoma, cataracts, slowing of the pulse, fluid retention, depression, and destruction of bone in the thighs and pelvis. Ironically, steroid drugs can cause joint damage as well as relieve it.
- Opioid drugs such as tramadol (Ultram) are used to manage round-the-clock pain. They frequently cause constipation, nausea, dizziness, drowsiness, and a plethora of other side effects.
- Chelating agents such as penicillamine (Cuprimine) depress the activity of the white blood cells known as T-cells. These cells, however, also fight viral infections. In addition to interfering with immune function, penicillamine causes digestive upset and alteration of the ability to taste.
- Disease-modifying anti-rheumatic drugs, also known as DMARDs, slow the progression of RA, but not without cost. One of the most commonly used DMARD drugs is methotrexate (Methotrex), which is also used to fight cancer. Methotrexate works by keeping cells from using the B vitamin folic acid. This stops the activity of white blood cells in joints, but it also interferes with the production of red blood cells, with repair of tissues, and with the normal function of the immune system. Cimzia (certolizumab), Enbrel (etanercept),Humira (adalimumab), Kineret(anakinra),Orencia (abatacept),Remicade (infliximab),Rituxan (rituximab), and Simponi (golimumab) are used with and without methotrexate to reduce the activity of the immune system, but they also cause serious side effects, including increased susceptibility to cancer.
- When these drugs don't work, doctors may prescribe other potent immune-modulating medications such as Xeljanz (tofacitinib) and Imuran (azathioprine). These tend to be drugs of last resort that have serious side effects and come with a serious price tag, about $10,000 a month before insurance and various discounts.
The new targeted medications for RA are likely also to be extremely expensive, but they may not have the side effects of other agents.