What Is the Safest Treatment for Rheumatoid Arthritis?

iStock/demaerre

If you suspectyou may have rheumatoid arthritis (RA)—or your doctor has recently diagnosed you—then you’re probably already experiencing the classic symptoms of painful, achy, and swollen joints, especially first thing in the morning or after a long day sitting at work.

与其他类型的关节炎,可以布拉夫t on by too much activity, rheumatoid arthritis symptoms tend to happen when you’ve been at rest, not using your joints. Maybe you wake up in the morning and feel stiff. Or maybe you get out of the car after a long trip and find your body will barely move. The discomfort in your joints is the result of an overactive immune system that mistakenly attacks the tissue that lines your joints. The result is pain and inflammation and, over time, damage to the joints that can lead to deformity and disability. You may not know anyone else with the disease, but if you have rheumatoid arthritis, you’re in good company: RA is the second most common type of arthritis, affecting 1.3 million Americans.

The good news about rheumatoid arthritis is that there are many different治疗方案. “When someone comes in with rheumatoid arthritis, I tell them that I can get them feeling better and halt the progression of their disease,” says Rebecca Blank, M.D., Ph.D., a rheumatologist at NYU Langone Health in New York City. The question is, which treatments work best and which ones are safest? Start with these joint-saving options.

What Drugs Are Used to Treat Rheumatoid Arthritis?

The类风湿性关节炎药物you’ll wind up on will depend on your symptoms and disease severity. To help lessen your pain and inflammation, your rheumatologist (that’s the type of specialist you see for RA) may suggest over-the-counter or prescription non-steroidal anti-inflammatories (think ibuprofen or naproxen) or a short course of corticosteroids. But the ultimate goal is to stop or slow the progression of the disease, preventing potentially debilitating cartilage and bone damage. For that, your physician will likely start with disease-modifying anti-rheumatic drugs (DMARDs). These medications slow down your overactive immune system, so it doesn't attack the tissue lining your joints.

Which medication specifically your doc chooses depends on your disease severity. “If someone has low disease activity, we may offer hydroxychloroquine, which is the least immunosuppressive of the bunch,” says Saika Sharmeen, M.D., assistant professor in the division of rheumatology at Stony Brook Medicine in Stony Brook, NY.

For more moderate-to-severe diseases, the starting point is typically methotrexate. If that isn’t helping, your doctor may switch to biologic drugs. Biologics are monoclonal antibodies that target cells called cytokines, which are involved in the immune response that causes inflammation. They include tumor necrosis factor inhibitors (TNF-inhibitors), B-cell inhibitors, T-cell inhibitors, and different types of Interleukin inhibitors. “When DMARDs aren’t enough, we add on a biologic, or something called triple therapy, which is three oral medications at one time,” says Dr. Sharmeen.

Rheumatoid Arthritis Drugs With The Least Side Effects

First, let’s get this out of the way: All drugs come with side effects. Your physician will balance your quality of life with the severity of the disease when choosing the right med for you. The RA drug with the least side effects is hydroxychloroquine (Plaquenil). “We don’t consider it immunosuppressive, and it doesn’t cause elevated liver markers or kidney issues like some of the other drugs,” says Dr. Sharmeen. However, that doesn’t mean it’s without side effects at all. “We have patients monitored by an ophthalmologist for retinal toxicity, which can happen over 10 years,” she says.

Methotrexate, considered a first-line drug for moderate RA, is also well tolerated. But it can cause elevated liver enzymes. When choosing between the two, your doctor will consider your lifestyle. For example, if you drink alcohol, methotrexate may not be your best option.

Which Is Safer: Methotrexate or Leflunomide?

These two DMARDs have a very similar safety profile, says Dr. Sharmeen. Yet, methotrexate is considered a first-line drug, while leflunomide is a second-line medication. Why? “Methotrexate is tolerated better and works a little better for rheumatoid arthritis,” she says. Research has shown more improvement when methotrexate is the initial medication. A study published inRheumatology表明，甲氨蝶呤的改善在一年后比服用leflunomide为ra的那些改善更重要。

Are Biologics Safer Than Methotrexate?

Oral drugs such as methotrexate can cause non-serious immediate side effects such as nausea and GI issues. They can also cause hair loss. "With biologics, we don’t see those immediate side effects, but they have a potential for more serious side effects—even though we don’t see them often,” says Dr. Sharmeen. The most commonbiologics side effectis a skin reaction at the injection site. The most severe side effects are the potential for infection, including the reactivation of conditions such as tuberculosis and hepatitis B, increased risk of certain cancers, and liver damage.

Talk to Your Doctor About RA Treatments

When taking meds, you should discuss a few things with your rheumatologist. For starters, tell your doctor if you’re planning to start a family shortly (whether you’re a woman or a man). “With some of these medications, you want to be off it for about three months before trying to get pregnant, or trying to get your partner pregnant,” says Dr. Blank.

另一方面，DMARDS磺基碱和羟基氯喹对怀孕安全，因此如果您计划怀孕，您的医生可能会启动您的医生。理论上，您可以在某些TNF抑制剂生物药物上，直到您的第三个三个月，Sharmeen博士说。“但是唯一一个安全的是Cimzia，”她说。

You also want to talk about your lifestyle. For example, if you drink alcohol your doctor will avoid a drug that affects your liver enzymes. And tell your physician if you tend to get a lot of recurrent infections, upper respiratory infections, or are around young children who may pass along infections—your doctor may choose a less immunosuppressant drug if your situation makes you more vulnerable to infections. “These are all important things for your doctor to know to find the right for you,” says Dr. Sharmeen.

Meet Our Writer

Krista Bennett DeMaio

Krista Bennett DeMaio has well over a decade of editorial experience. The former magazine-editor-turned-freelance writer regularly covers skincare, health, beauty, and lifestyle topics. Her work has appeared in national publications and websites includingOprah,Women’s Health,Redbook,Shape,Dr. Oz The Good Life, bhg.com, and prevention.com. She lives in Huntington, New York with her husband and three daughters.

What to Read Next

What Are the Four Stages of Rheumatoid Arthritis?

What Systems of the Body Are Affected by Rheumatoid Arthritis?

What Is the Difference Between Rheumatoid Arthritis and Arthritis?

多长时间Does a Rheumatoid Arthritis Flare-Up Last?