What are the treatments for rheumatoid arthritis?



The Facts on Methotrexate for Rheumatoid Arthritis Treatment

Methotrexate is the most commonly prescribed drug to treat rheumatoid arthritis, yet it only helps about half of those who try it. Find out how it works and how to lessen its side effects.

By Karen Appold

Medically Reviewed by Alexa Meara, MD

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Your doctor may be able to change your dosage schedule if you have side effects from this drug.
Your doctor may be able to change your dosage schedule if you have side effects from this drug.
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For people who have more than mild symptoms of rheumatoid arthritis, or RA, methotrexate (Rheumatrex, Trexall) is one of the most commonly prescribed drugs. It's a leader in a class of drugs known as DMARDs – for disease-modifying anti-rheumatic drug – and it works to slow the progression of joint damage from the disease.

How Methotrexate Helps Ease Inflammation

Methotrexate works by reducing the function of the cells that are causing inflammation in the joint tissues. "Its use can reduce inflammation and therefore should help relieve pain and protect from joint damage," notes , a rheumatologist and associate professor of medicine at MedStar Georgetown University Hospital in Washington, D.C. Less inflammation in the joints should mean less joint pain and less joint swelling. You should also feel less fatigue and less morning stiffness.

People with swollen and painful joints whose rheumatoid arthritis has not improved with initial, non-drug therapies will most likely be prescribed methotrexate for RA management. But it may take weeks to several months until the full benefits of methotrexate are noticeable, says Barbara Young, PharmD, MHA, editor of consumer medication information for the American Society of Health-System Pharmacists in Bethesda, Maryland. While you’re waiting for the effects to start, you may be given other medications, such as corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs), to help you manage your RA symptoms.

The goal is to feel more and more improvement over a few months, reaching a level of stabilization after four to six months. But methotrexate doesn’t work for everyone. The drug is a slow but steady process, taking about 5 to 6 weeks to start working, says Dr. Whelton. "I find about half of people will experience relief with methotrexate alone, while the other portion usually adds other medications to treat their RA."

According to a research review, published in January 2013 in the journalBMC Medicine, that analyzed predictors for methotrexate success, men respond better than women, non-smokers respond better than smokers, and people who take methotrexate as their first DMARD do better than people who have already tried another drug in this category. The review also found that those who take methotrexate in an early and mild stage of RA do better than those who start the drug after they have had RA for a long time. The researchers point out that if doctors can identify who is unlikely to respond to methotrexate, those patients can be spared exposure to a potentially toxic drug.

If you do not have a significant improvement in joint inflammation and well-being after about three months of RA treatment, your doctor will probably consider adding another drug to your treatment, especially a biologic drug such as etanercept (Enbrel), adalimumab (Humira), or infliximab (Remicade). The treatment goal is to achieve early, complete (or near complete) control of joint inflammation so there’s less risk for long-term damage to the joints over the years.

Dealing With Methotrexate Side Effects

Because methotrexate affects rapidly dividing cells that line the mouth and stomach, very common side effects such as painful mouth ulcers, nausea, and diarrhea may result. "People on methotrexate may also suffer from fatigue," adds Whelton.

Call your doctor right away if you have diarrhea, mouth sores, dehydration, bleeding, shortness of breath or cough, any signs of an infection, or a rash.

Methotrexate can lower your white blood count, which can make you more likely to get an infection. It can also cause hair loss and make you bruise more easily. Some people get headaches and fatigue for a day or two after taking methotrexate, which is usually taken by mouth once a week. "Another dosage schedule for methotrexate oral is to take the weekly dose in divided doses every 12 hours for 2 doses (within 24 hours)," says Dr. Young.

Because methotrexate can lead to spontaneous abortions, women taking this RA drug should take precautions to prevent pregnancy. Women should also use a contraceptive if their sexual partner is taking methotrexate. "Reliable contraception must be continued for three months after men stop taking methotrexate and for women until after they have had their menstrual cycle return," Young says. "Women must notify their physician immediately if they think that they may be pregnant while they (or their partner) are taking methotrexate."

To prevent mouth pain, ulcers, and nausea, a low dose of folic acid, a B vitamin, once a day, can be considered. In addition, your doctor will want to do blood work, including a chemistry profile, every month to monitor your white blood count. After a few months of monitoring, you should be able to reduce the frequency of blood tests to once every two to four months. People living with rheumatoid arthritis and kidney disease may be especially susceptible to the side effects of methotrexate and instead may need to take a different medication for RA treatment.

Long-Term Issues: Possible Liver Problems

It's important to screen on a regular basis for liver irritation, says Whelton. "While mild liver inflammation is not uncommon, serious liver disease is rare." Blood tests can check for liver problems. If your liver test is abnormal, your doctor may lower your dose of this RA drug or stop it temporarily. Later on, your doctor might start you on methotrexate again at a lower dose.

Alcohol increases the risk for liver inflammation when taking methotrexate and should be avoided.






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Date: 04.12.2018, 20:39 / Views: 85161