Rheumatoid Arthritis (RA) Symptoms, Signs, And Medications For Treatment | Yingqi Zhang, PharmD | RxEconsult

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Rheumatoid Arthritis (RA) Symptoms, Signs, And Its Treatment With Medications Category: Rheumatoid Arthritis & Inflammatory Conditions by - August 25, 2015 | Views: 54975 | Likes: 0 | Comment: 0  

Diagnosis of Rheumatoid Arthritis

Diagnosis  depends on the  physical exam and blood tests. Blood tests suggestive of  RA include anemia (low red blood cell count), presence of rheumatoid factor (a protein found in about 80% patients with RA), and an elevated erythrocyte sedimentation rate (a marker that indicates an ongoing inflammatory process). Radiographs (or X-rays of the affected joints), ultrasound and MRI can also be used to detect RA and determine its severity.

Medications For Treatment Of RA

The goal of RA treatment is slowing down or stopping the progression of the disease. There is no cure for RA.  Oral corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to improve symptoms and quality of life. Ultimately, patients should receive disease-modifying antirheumatic drugs (DMARDs) to slow down the progression. DMARDs can be categorized as non-biologic  or biologic DMARDs.

Non-biologic DMARDs

Non-biologic DMARDs can be given orally and  are  available in generic form  They suppress  immune function and inflammation. Common non-biologic DMARDs include:

  • Methotrexate (Rheumatrex, Folex)
  • Hydroxychloroquine (Plaquenil)
  • Leflunomide (Arava)
  • Sulfasalazine (Azulfidine)
  • Minocycline (Imuran)

Methotrexate or leflunomide alone is recommended as the initial treatment for RA according to American College of Rheumatology. If methotrexate or leflunomide fails, dual  or triple DMARD combinations can be considered. 

The effectiveness of DMARDS is measured by the response rate. ACR 20/50/70 indicates 20%/50%/70% improvement in physical function and health-related quality. At 12 months with methotrexate alone, the ACR 20 response rate was noted in  35%-57% of patients. The ACR 20 response rate was achieved in 45% of patients taking leflunomide. Combination therapy usually demonstrates higher response rates than monotherapy. For example, the combination  of methotrexate, hydroxychloroquine and sulfasalazine resulted in an ACR 50 response rate in 77% of patients with two years of treatment. This is significantly higher than methotrexate alone  which only yielded an ACR 50 response rate in  40% of patients. The common side effects of non-biologic DMARDs include myelosuppression (fever, infections, and low white blood count), easy bruising, diarrhea, nausea, dizziness and elevation of liver function tests.

Biologic DMARDs

Biologic medications are  large molecule  antibodies and fusion proteins, derived from living organisms. They  modulate the biologic response caused by RA. Biologic DMARDs  are indicated for  patients with moderate to severe RA who have an inadequate response to methotrexate and  other nonbiologic DMARDs. Several biologic DMARDs have been developed to target TNF, a marker of inflammation. Therefore, biologic DMARDs are  categorized as anti-TNF biologics and non-TNF:

Anti-TNF biologics 

  • Adalimumab (Humira)
  • Etanercept (Enbrel)
  • Infliximab (Remicade)
  • Certolizumab pegol (Cimzia)
  • Golimumab (Simponi)

Non-TNF biologics    



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