What is rheumatoid arthritis?
Rheumatoid arthritis is a chronic inflammatory disease. It can affect many parts of the body, but usually the small joints of the hands and feet are affected. Rheumatoid arthritis causes joint pain and stiffness that interfere with daily activities. Over time, the joints can actually be destroyed by rheumatoid arthritis, leading to loss of use. This damage can begin in as little as a few months after you first notice symptoms. For this reason, early treatment with medications that slow joint damage is important.

What medications are used for rheumatoid arthritis, and how can they help?
Medications can help with pain and swelling. Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen (Motrin, Novo-Profen in Canada), celecoxib (Celebrex), and naproxen (Naprosyn, Naprosyn SR in Canada), and corticosteroids (e.g., prednisone) are used to get symptoms under control quickly. These medications don't stop or slow disease progression. But several medications do slow or stop the progression of rheumatoid arthritis. These medications are known as disease-modifying antirheumatic drugs (DMARDs for short). Examples include methotrexate, leflunomide (Arava), sulfasalazine (Azulfidine, Salazopyrin in Canada), hydroxychloroquine (Plaquenil), infliximab (Remicade), etanercept (Enbrel), and adalimumab (Humira). Often two or even three may be used in combination. The prescriber will choose a medication regimen based on how bad your rheumatoid arthritis is, how long you have had rheumatoid arthritis, and the medications' side effects.

What are the side effects of these medications?
Rheumatoid arthritis medications are generally well tolerated. You will be monitored frequently to help decrease the risk of side effects. You should ask your prescriber or pharmacist to review the side effects of your rheumatoid arthritis medications with you. Ask what problems you should look for and which to report to your prescriber. For example, most medications that slow or stop the progression of rheumatoid arthritis can interfere with your body's ability to fight infections. If you get an infection while taking one of these medications, you will need to contact your healthcare provider. You may also need a blood test periodically to make sure the medication is not causing liver problems, anemia, or other blood problems. If you receive hydroxychloroquine, you will need a special eye exam, as often as every three months in some cases. There are concerns that some rheumatoid arthritis medications may increase the risk for heart failure or cancer. These side effects may sound scary, but the benefits of rheumatoid arthritis medications, such as less pain, easier movement, and slowing of joint damage, outweigh the risks for most patients.

What do I need to tell the prescriber before I start taking medication for rheumatoid arthritis?
For safety's sake, you will need to tell the prescriber if you have ever been diagnosed with liver disease, kidney disease, heart failure, or cancer. You will also need to let the prescriber know if you are pregnant or intend to become pregnant. You should also tell the prescriber if you may have been exposed to tuberculosis (TB) or hepatitis. You will need simple blood tests and maybe a TB skin test. You will probably be advised to get a flu shot, and possibly be vaccinated against hepatitis B and pneumonia.