For Your Patients: Starting Treatment for Rheumatoid Arthritis

Today there are many treatments available to control rheumatoid arthritis (RA), and treatment can be tailored to your particular pattern of symptoms and response. The majority of patients with RA now can lead full lives, but it's important to follow all your rheumatologist's instructions.

What is the First Step in Treatment?

Treatment for RA usually begins with a drug called methotrexate, which is known as a disease-modifying antirheumatic drug, or DMARD, because it has been shown to help prevent disease progression and damage to the joints along with reducing swelling and pain.

You may have heard of the newer medications, including biologics such as Enbrel, Remicade, and Humira, that are highly effective for RA and other autoimmune diseases. But these drugs are very expensive, and because of their major effects on the immune system, can increase the risk for severe infections and other problems. Biologics and other newer medications are not typically used until after treatment response has been inadequate with a conventional DMARD such as methotrexate.

What Side Effects Can You Expect?

Methotrexate has been used for many years as a treatment for cancer. But when used for cancer, the drug is given in high doses, and can cause a number of side effects. However, when given for RA, methotrexate is given in low doses, and serious adverse effects are quite uncommon. It's an unusual drug, in that you will take it only once a week.

The most common side effects associated with methotrexate are nausea and fatigue, but these can often be mitigated with adjustments to the dosage and by the co-administration of folic or folinic acid.

Who Should Not Take Methotrexate?

Certain patients should not take methotrexate, so tell your doctor if you have a history of kidney or liver problems.

What Else Will Treatment Involve?

Because it can take several weeks for the benefits of DMARD treatment to appear, your doctor also may prescribe a short-course -- less than 3 months -- of a steroid such as prednisone, which can help to rapidly alleviate your symptoms.

If you do not respond to DMARD therapy within about 3 months, you and your doctor can discuss the many other treatment options now available, with the goal of maintaining a state of low disease activity or even remission.

It's also important throughout treatment for RA to maintain a healthy lifestyle, following a healthy diet, exercising, and especially avoiding smoking, which is a strong risk factor for RA itself and for having worse disease. Lifestyle modifications also can help prevent important complications of RA such as heart disease.

Read previous installments in this series:

Part 1: What Is Rheumatoid Arthritis?

Part 2: How Is Rheumatoid Arthritis Diagnosed?

"Medical Journeys" is a set of clinical resources reviewed by physicians, meant for the medical team as well as the patients they serve. Each episode of this 12-part journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.