Without treatment, joint inflammation can cause permanent damage. Doctors know that it is wise to prescribe a disease-modifying antirheumatic drug (DMARD) before such damage occurs. People newly diagnosed with an inflammatory form of arthritis, such as rheumatoid arthritis, may be prescribed a DMARD upon their diagnosis.
Another reason DMARDs should be started early is that, although they are generally effective, they take a long time to show results. For example, hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine) may take up to three or four months before effects are noticed. Other drugs, such as methotrexate, work more quickly, but often not quickly enough. For that reason, doctors frequently prescribe an additional drug – such as a corticosteroid or an NSAID – to help control pain and inflammation while the DMARD starts to work.
DMARDs are most commonly used for rheumatoid arthritis, but some are also used for juvenile RA, ankylosing spondylitis, psoriatic arthritis and lupus. Some, such as chlorambucil (Leukeran), mycophenolate mofetil (CellCept) or cyclosphosphamide (Cytoxan), are used mainly to treat severe organ disease, such as kidney disease caused by lupus or vasculitis. The dosages listed in this chart are for those with RA; your dosage may vary depending on your specific condition and factors like disease severity, age, body weight and other medications you are taking.
Only three DMARDs – auranofin (Ridaura), leflunomide (Arava) and Azulfidine – were actually developed for rheumatoid arthritis. The others were borrowed from different areas of medicine: Hydroxychloroquine (Plaquenil) is a malaria drug, chlorambucil (Leukeran) and methotrexate are cancer medications and cyclosporine (Neoral) originally was developed to keep the body from rejecting transplanted organs.
Because DMARDs suppress the immune system, always watch for signs of infection – chills, fever, sore throat or cough – and report them to your doctor. And check with your doctor before getting any vaccinations.
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i am a 44 year old male with Psoriatic Arthritis for 27 years
And I have taken all of the medications listed above. Although this article was somewhat informative if you are looking for the correct spelling it didn't say much else. There are lots of other drugs they didn't mention.
I have also taken Embrel, Remicade,Humria and one other I can't remember its name. Until I acquired MRSA (A possibility they forgot to mention).
But I can give you some advice I wish someone had given me. Be proactive at all costs, know everything. Be a smarty-pants when you go to the doctor. You are in charge, it's your life. You're the one that has to live with the pain. You are the person giving up everything for your illness. Doctors don't always know best, you know your body better than anyone else
Peter-I'm very sorry about the loss of your daughter. Please know that RA is a monster and it knows no age or gender. It can be well controlled with meds and yet some of the meds could kill us. However, quality of life means so much to us all.
I became a severe anemic on metrotrexate and ended up needing an emergency blood transfusion. My current rheumatologist DID NOT take me off the medication after the incident. I took myself off and demanded another rheumatologist and after 4 months my bloodwork is back to normal. We have to be our own advocate when it comes to these dangerous meds. Don't blame yourself as we all resarch and learn so much when this monster hits us or a loved one. May god bless you and your family.
All the rest of you should visit and join DAILYSTRENGTH.COM They have a RA group that has over 2500 members. People talk about current problems and treatments as well as offer support for eachother. No one really answers you here. Good luck to you all.
You stated being surprised about some of the comments you've read here? I'm curious to know what specifically 'surprised' you?
One of the lesser advertised "treatments" with autoimmune disease, however, are dietary changes and supplements. I have many patients who have had good success in avoiding gluten and thus decreasing or eliminating their RA symptoms. A gluten free diet can also help psoriasis and psoriatic arthritis. Fish oil is a great anti-inflammatory supplement. Boswellia is another.
There are many times that I will examine a patient and find obvious inflammation such as swollen joints, and yet their blood work does not show any changes. I treat what I see and what my patients report, not necessarily what the blood work shows. You are a whole person, not a number on a piece of paper! Don't let anyone treat you as such. In my area Rheumatologists are few and thankfully the group I work with is knowledgeable and caring. If you are diagnosed with any type of inflammatory arthritis such as RA or psoriatic arthritis, get a referral to a RHeumatologist right away! It is in your best interest to do so. You don't have to just "deal" with the pain. There is a whole lot more going on besides pain. RA will destroy your joints and cripple you if left untreated. Your body is attacking itself. There is effective treatment and there is hope. Don't be afraid to ask questions or to get a second opinion.
you will find just as many people who say that the meds worked for them as you will find say they didn't or caused terrible side effects. The meds are not without risk, just like anything else. But sometimes the side effects are a lot better than the long term consequences of untreated disease. This is one area in which I believe complementary medicine is a very good adjunct to traditional medicine. Good luck!
I am SO sorry it took me so long to check back on this site and I'm so glad I did. Thank you first of all for your kind words. We've all heard that losing a child is the worst possible tragedy in life and im here to tell you that it goes far beyond that. Anyway, my daughter, Patrice was in the 5th grade when she began having symptoms of JRA... She was first treated with Prednazone alondg with Folic Acid etc.. which completely transformed her thin lanky body into an inflated balloon. Her doctor was the Chief of Rheumatology at Stanford Children's Hospital in Palo Alto, CA. Patrice was then treated with methotrexate via injection (LARGEST needle I had ever seen)..eventually she was prescribed pill form.. she took it on and off for several years and ulitmately went into remission reverting back to her slim figure and all symptoms disappeared. For her high school graduation, an aunt had given her a trip to New York City as a present. Although it has been written in numerous articlae Ive read to stay away from large crowwds in public places to limit any risk of being infected from others, she and her aunt were on tour buses, subways, airplanes etc surround by thousands of tourists etc. Upon her return home, she started college for one day and then became ill with sore throat high fever of 103.7 and severe nausea. I had taken her to a Kaiser ER 3 times but they never admitted her. On the 4th time, she went into shock and cause of death was incomplications of infectious mononucleousis including ruptured spleen, anemia and low platelet counts. Methotrexate is SO toxic and powerful that people sometimes dont experience any side effects until months after stopping treatment.. Had I know, I NEVER wouldve allowed thids drug to be part of treatment... i HOPE for the best for your girls.. you sound like a wonderful Mom and I want to give you my email addrsss in case you want too keep intouch and.or need advice in any way.. Email me at peter.lekas@coldwellbanker.com Kind regards, -Peter PS: FGO to the following web site and light a candle if you wish to http://pclwithlove.memory-of.com/About.aspx
Sheryl
im suffering from RA since 1992.i would like to get more deatil on medicine which work more effectively & for long period,that to avaliable in india
You said you were scared to start taking Plaquenil because you heard it causes hair loss. I've been on Plaquenil for 7-8 years and I have hair to my waist and my ponytail is as big around as a lemon. I'm 52 years old and had my first flare at 35; the doctors thought it was bursitis, then a pulled muscle, etc. I was in my mid-forties before I got the news...it was RA. Because of that I already had some damage and some catching up to do with a DMARD. Plaquenil works amazingly well for me. I used to have flares (excruciatingly painful flares) about 5-6 times per month. Now I have tiny flares (more annoying than painful) 2-3 times a year and ibuprofen knocks them out. While taking Plaquenil, you need to get your eyes checked 2-3 times per year (I've not had any problems there either). The ONLY side effect I can remember having in the very beginning was nausea and diarrhea in the mornings for an hour or so. That only lasted a couple of weeks though while my body acclimated. It has been a miracle drug for me, please give a try if that's what your doctor wants you to do.
Methotrexate...lost a little hair...regular blood tests (weekly after first dose, then monthly, then I am now at quarterly).
I could not move, hug my children, cook dinner before I had this drug. And whilst I appreciate their can be side affects I have lived the last 5 years relatively pain free and normally. There was no choice.
I was scared of it at first, but I talked to my doctor and got the facts. May I suggest this for advice rather than just accepting others (including mine).
I have two friends who have been on this drug for 15 years and seem fine. But everyone is different.
I've been on and off Prednisone for a few years - wonderful til you are off it when the pain is twice as bad as before. Am considering a pain med finally since you can't stay on prednisone forever, but, am concerned about becoming too dependent on them. Not sure if there's anything left (in pill form) that I can take that will help.
Any ideas?
Thanks
I was diagnosed with RA last fall at age 65, so it happens. My mother had it starting at age 40 - so I feel lucky it took so long to get me.
Good luck.
Judy
is there anyone you have ever heard of getting r.a.this late in life
I've made many changes in order to fight this disease. I am 49 and I do not want to become "old" before my time. I am just so frustrated because a year ago I didn't even take a tylenol and now I am eating pills all week. Is there ever relief? I feel I haven't found anything that really is changing much. My stomach hurts now because of all the pills and sometimes I feel like giving up hope and just taking the the disease that the good Lord for an unknown reason to me has given me and going with it. Has anyone found anything better than what I am taking for mediation? Mine seem to be the "norm".
I've been on methotrexate injections for probably 6 years. (The pill made be nauseous.) I follow that with leucovorin the next day, and arthrotec 75 am 50 pm. I get multiple shots of cortisone throughout the year and take prednisone for the flare ups.
Lately, the flare up have been much more frequent. Dr. said add plaquenil. I checked out the side effects and the sites said it could cause psoriasis flare ups. I have psoriasis and really don't need yet another difficulty. Does anyone know about this possible side effect? I'm also wondering if you need to change the NSAIDs from time to time?
I saw above that someone started minocycline. I was just started on that too and there seems to be some functionality improvement(hands still all swollen up but they work better.) If you haven't found it already, there is an entire site dedicated to the use of minocycline(www.roadback.org). Lots and lots of information.
Also saw above, several people praising the biologics. If they work, they are a miracle, but there are serious side effects. Embrel was the first thing my Doc put me on. Buried in the 40 page side effect notice was transverse myoletus. Got a mild case with my second dose and have never recovered(it's nerve thing, pain and creepy-crawlies on one side of my body).Please research and carefully conisder what the doc is pruposing.
Your thoughts?
We are new to this but not to medical as we have several children with serious medical issues. She also has Type 1 Diabetes and several other diagnosis.
Thanks
I feel for you. MRSA is a terrible thing and with everything else you've got going on there's not much that can be done.
My two-week bout of Pristiq put me over the edge and I'm at the point, NO MORE MEDICATION; I'm tired of feeling like crap all the time, I'll just deal with the pain. And since I've taken this attitude I'm much happier. Plus my rheumy is afraid to put me on anything else because of my reactions.
So the only suggestions I can make would be to try to eat stuff to pump up your immune system to at least keep you healthy.
Try your best (I know this can be hard) to keep a positive attitude and a good sense of humor and don't worry that you've become a couch potato which was the hardest thing for me. I felt/feel so useless, but I do what I can and when I can't do anymore I don't. By giving myself the down time I do much better than if I push myself, by taking a rest, even if it's ten a day, I can do more because when I overdo it I end up in bed a couple of days, so I've learned. And when people comment on the way I walk, I just joke and tell them, yeah, today I got that board shoved up me sideways, which usually gets a laugh, which is the best medicine in the world.
As for the pain you live with if possible, try to keep pain medication at a minimum; use ice packs, heating pads, epsom salts baths, rice packs that can be heated in the microwave, if possible try to do some stretching exercises throughout the day, and when you absolutely can't stand the pain, lay down and take a nap; if it takes six pillows to get you comfortable, use them! My poor husband has slept on the couch the past five years because I need the whole bed to get comfortable.
Also, a heated mattress pad is wonderful. I wake up stiff every morning, but the constant heat throughout the night seems to help; at least my muscles don't feel as though they want to cramp when I get up.
I hope this helps.
jan
I'm a 53 yr old female, and was diagnosed with ankylosing spondylitis, but I never told my dr I was having problems until April 2008. I just thought being a clutz was catching up with me. I carry the HLA B27 gene, as well as my daughter and my oldest brother--brother is off and on in a wheelchair, 50 yrs ago my grandfather was confined to one. Mine started about 15 yrs ago with my shoulders and lower back aching, then the hips started, but everything got worse when I was rear-ended in Aug of 2008. I now walk with a limp due to the hip pain, and have a hard time sitting because of the back and hip pain, so I had to quit my job. To date I have been on Sulfasalzine, Methotrexate, Humira, Cymbalta, Lyrica, Neurontine, Enbrel, and Savella with side effects ranging from kidney infections, respiratory infections to severe constipation, due to the lack of intestinal motility because of the massive abdominal adhesions I have from numerous surgeries. I've had an injection in the lower back and in the hip, with no luck. Both doctors, family and rheumy, said I should have complained years ago, that the damage is already done. My regular doctor started me on Pristiq today, not for depression, he explained something about the neuro transmitters in the brain, so time will tell. Hopefully, you won't have any problems with the medication. But do give them a chance. I have low resistence to infection anyway, and some of the meds lowers it more. In talking to my rheumy dr, he said some people just can't take the medication, and I'm one of the unfortunate ones, I guess. Wish you the best of luck.
And I'd like to add that I had a very severe onset (triggered by dysentery from working in a developing country) with aggressive symptoms (jaw pain, sternum pain that restricted breathing, could not walk at all, hip pain, fingers swollen, sausage toes, back pain), and the sulfasalazine actually counteracted the symptoms very quickly. I went from losing the ability to walk (because of pain and spasms) to resuming running and standing for long periods without back pain.
One strange symptom though is that my immunity has actually increased. It's supposed to be an immune suppressant, but not in my case. I used to get every single cold and flu that went around, but in the 6 years I've been taking it, I only had swine flu which lasted only 2 days (I went through the entire spectrum of symptoms in two days). Also, I do get iron deficiency anemia now, but experience no other side effects.
For fatigue, which this medication does not help, I've found great luck in taking spirulina (at the highest dosage). It's given me back more energy and elevated my mood. So if you think you can tolerate a sulfa medication, try asking your rheumy. For those who can tolerate it, it seems to work excellently. Good luck!
It feels "at home" this forum. I have been reading, and feel my experiences may have something to contribute and spark discussion.
I've been "diagnosed" with sero-negative undifferentiated polyarthritis - which is sort of just a label because I have inflammation, multiple joints, but tests did not indicate RA, lupus, and various spondyloarthitis.
All this started about 10 weeks ago. I had some dental surgery under general anesthesia, then a week later severe diarrhea, and following that stiffness and pain started in mid-back, spread to lower, hips, R knee, R palm, L elbow.
Then i went to see a rheumatologist, switched my Ibuprofen to Nabumetone. Took that for a few days, then my hip/knee pain went to 10 on a 10- scale, at which point he put me on 30 mg prednisone. Did wonders, except pain returned as we tapered towards
zero. In 2 weeks. Also got a new joint ( L ankle). Then he put me on Meloxicam (Mobic), which did wonders on my critical hip/knee, but failed to address other joints. At the next visit in mid-July, my CRP was very high (10) and so he thought I need to go on DMARDs right away - either Plaquenil or Methotrexate.
I'm concerned about 1) the need to take the lifetime, 2) the low probability for any one of the long list of drugs, that it would actually work, and 3) all the sided effects.
So, I started a course of homeopathy (16 years ago, this doctor treated me, when I had had 11 years of severe back, hip, knee problems - and I've been fine until now). But this time i had to consult him over the phone. I also did a major diet restrictions ( cut : citrus, ,sweets, and limited wheat and dairy) - thigh my regulate diet was already very "good". I'm also taking fish oil supplements, MSM/chondroitin/glucosamineand occasional Vicodin.
Where am I today? When I started this treatment 3 weeks ago, my knee, elbow, finger, ankle problems varied in a 2-5 range on a 10-scale. Today Id put my pain at 1-3. My last two CRP levels were 4.3 and 3.9, high but down from 10 earlier. ESR is still high at 60 (earlier 21-31) but i understand it's a delayed response. Ankle swelling limits my walking and
standing, and Elbow swelling, pain is also restrictive. But i exercise in a pool 70 minutes every day, have resumed bicycle to work.
I want to try this out another 5 weeks. If inflammations lasts, then I have to consider the DMARDs. Though if it is mild, as its been lately, i wonder what the risk of joint damage is. does anyone understand how and whether the risk correlates with the severity of inflammation?
Do any of you consider alternative treatments?
Cheers,
Hemant
My doctor wants me to go on plaquenil. I am concerned about the long and short term effects of it. I also take two tablets of ultram daily for pain which helps a great deal and also 2-4 tablets of nordic fish oils and one tablet of flaxeed oil as well as try to each more fish. I find the fish and flaxeed oil make a huge difference in feling better and if I stop taking them, the difference is immediately noticeable.
Please let me know if anyone has any thoughts on the negatives or positives of plaquenil.
After having both hips replaced 3 years ago and a lifetime of back pain, 10 years of knee pain, etc., I was diagnosed 2 years ago with not only osteo-arth but also RA.(my second auto immune disease-thyroid disease was first) Started two years ago with our beloved Pred. and 10mg Methotrexate per week. Flares were treated with Pred dose packs. New doc doubled the meth last Aug. to 20mg per week. THREE mos. later, my hair started falling out noticeably. We lowered metho to 10mgs(each pill is 2.5). 3 months later, flares started up. We increased to 15mgs. Hair not really growing in, not falling out as much, but still losing more than i should, still having some flares. He is asking ME if i want to start adding biologics. ADVICE???
Finally I went to a rheumatologist, and it turns out I have psoriatic arthritis. She put me back on Prednisone (20mg a day) and wanted me to do some thinking about starting up on Methotrexate or Sulfasalazine. Scary.
If anything, I have a lot of questions for her. This forum has been amazing to hear the different stories about all the DMARD drugs. It looks like no one is better than the other.
with RA. I was being treated by a rheumatologist. I thought the doctor knew what he's doing. That's why I was seeing a specialist. Despite the fact the RA treaments worked, I don't believe it was worth it. Now I have even more pain than ever. Beware the side effects are worse that you may think.
The doc prescribed prednisone 10mg and methotrexate 15mg with folic acid supplements.
Blood tests every 4 weeks 9/09. After Dec 09,
I went to 20mg metho. I have not had any serious side effects, just completely tired
and sleepy that day and the next. I'm down to 4 mg prednisone and 2-4 ibuprofren as needed.
My pain is only bad in my right wrist and fingers now. I was terrified to start methotrexate but it hasn't been bad.
I was diagnosed with RA over two years ago when I was 26 yrs old. I have been on plaquenil and it took awhile to kick in, but it really helped with the stiffness in the mornings. Didnt notice any side effects, but I still have swollen, red, puffy joints and my doctor wants me to start taking methodrexate because my xray showed joint damage starting on my pinky toe. I feel great, I am active, and I am scared to try this new drug in fear that it will make me feel worse, not better, but I also dont want RA to leave me disabled. I am meeting with him soon to discuss the drug. I am going to continue to stay positive and hope in my life time they find a cure! Good luck all!
please have x-rays every year...they will interfere with my breathing and then what???This is very upsetting to me, you think you are doing what is best then it turns around and kicks you in the gut.
I was diagnosed w/RA a year ago. My Reumy Dr. instantly put me on Plaquenil (200mg 2x day) but also added Fish Oil tabs (6 per day) Vit D & E and SamE. This combo has worked beautifuly for me...no side effects..and no problems with my immune system. I have been in remission for 3 months (no swelling or pain) but now feel it coming back. My Dr. wants to add methotrexate as the next step, I'm nervous about adding such a toxic drug to my system. Right now I'm focused on trying to keep a positive attitude and just dealing with things on a day to day basis! I wish better health to everyone! Lynne
See doctor tomorrow for updates.
I am also afraid to have to start taking methotrexate. Fortunately, I don't have to. I've been on Plaquenil for many, many years with great results. It is the safest of all the DMARD's (although some folks don't consider it a DMARD, my rheumy and I do). Even though my numbers were off the charts, you'd never know I had RA if you saw me. I do take Pred. and Advil during flares which are few and far between. Good luck.
I have had AS for approx. 55 years and was told by my Rhematologists that I had a relatively mild case. Anklosing Spondilytis (AS) can be and frequently is, a very serious disease, with possible heart valve problems, eye infections and extremely painfully hip/back/ribs/shoulder and neck joint pain. The good news is it tends to do all its damage over a forty/fifty year period and than burns out or goes away. The bad news is that all the damage it caused over that period now starts to flare up as a result of Osteoarthritis and I am once again experiencing severe, debilitating pain with weather changes. This year I had both shoulders completely replaced and my Dr. is now talking about doing surgery on my neck. I am going back to my Rhematologist to see if there is some other medicine that can help and not kill me in the process. There are a number of very helpful medicines but they can also be dangerous to your health/life but, had they been available 30 years ago, I would have undoubtedly tried them. Good luck Pat and hopefully your disease will a relatively mild case.
Cannot stress enough the importance of blood tests if you are on methrotrexate and another biological.
This year, my newest rheumie confirmed that I do have RA and wants to put me on Methotrexate, which he says is the next drug of choice. For some reason that drug really frightens me, so I've put off taking it. I've heard it gives you mouth sores, but I'm already dealing with that (which I think is due to the Naprosyn), hair loss, and weight gain to mention a few side effects that I remember reading about. I would be much more willing to try Celebrex, but he doesn't seem to want to go there.
I'm wondering if I should try taking 1-2 Tb daily of flaxseed oil, which I hear is good for RA and constipation (another problem caused by the Naprosyn).
Thanks
MIKE
Was reading all your comments!!
I have RA It's been 12 years and plenty of up's and downs Now with this weather being cooler I feel the ache's I am on Arava and also
Enbrel 2x week I give myself the shot.
Every day is different, when you have no pain enjoy as if it might be your last and you wake up the next day and a flare-up and no use to any one. Prednisone is great the wonder pill also has side affect's I have cataract's. So hope every one finds their way!!!
Think Positive.
It depends on your prescription, but methotrexate is not terribly expensive. At Costco, it's $17 for (30) 2.5mg pills. This would last for ten weeks for me. (Three pills a week.)
Ken
I was just diagnosed with RA two weeks ago.
the Dr. i saw gave me prednisone to take for 1 week just to keep inflam. down. boy does that work fast (although i was off the charts on my titer and i am RA+ he said i had a normal range sed rate-- of course i finally got in after a horrible flare was over.
I am uninsured and make too much to get assistance, I hear the meds are very expensive, i have yet to get into a Rhumatologist. anyone tell me the price of meds with no ins???
eg: methatrexate
hell- it's gonna cost from 300 to 650 just to visit the DR!!!
I'm glad there is a support group out there!
thanks
joyce
Monoundifferentiated arthritis of the rt clavicle. My rheumatologist says likely atypical rheumatoid arthritis OR spondyloarthropy. She is recommending methotrexate.
Prednisone and cortisone injections have provided some relief. My other primary symptom is fatigue.
Is there anything else I should ask or try before methotrexate? Sounds like I would have to be on that for the rest of my life?
I've been officially diagnosed with RA about 3 weeks ago. I'm an active 36 yr old woman. My mom has RA pretty bad and I just don't want to end up like this. I feel horrible for her because she just can't seem to find a drug that helps.
I've been on Plaquenil for almost 3 weeks and just recently added a 2nd pill making it 400mg/day. Just when my body was getting used to 200mg/day now I'm dealing w/the side affects. I don't like them and I'm really hoping this works. I'm curious about adding more fish oil to my diet as mentioned above. But what I did NOT know what that this drug lowers your immune system.
Anyone have any issues with this?
Thanks,
Steph
RA a year ago at first i was put on meteroate
I lost too much weight and then i was put
on humaria it helped alot I needed something
else So i was put on arava I've been taking
it for a week now so far so good I barely
have any pain now I am just looking for
the side affects now I hope It goes ok.
I spoke to my Dr about not going straight onto methotroxate at first and suggested we try a lower solution to my RA. This was agreed and I went onto Plaquenil and on my own accord I went onto at the same time 20ml of liquid fish oil a day.
Within 3 months my RA improved to the degree that I play golf at least 3 times a week.
I only see my Dr once a year now. At present I do not suffer from inflammation.
I believe fish oil has worked for me and suggest others might consider it.
Laurie
Hi. I just found out I have Ankylosing Spondylitis. Is there anyone out there who has this? I never heard of it until now, and I would like to hear from someone who has it also.
thanks,
Pat
Shelly
Excuse me, BUT... Am I the only man on earth that has arthritis? I certainly do not mean to offend anyone, but I'm feeling a bit alone here.
I have recently been told by my doctor
(a woman) :O) at the VA that I have arthritis in my back.
I have no idea what kind it is, and I understand there are over a hundred kinds it could be. In many cases of arthritis, they (doctors) don't have a clue as to what causes it.
About three months ago I began having severe back pain. It is now also in my left leg and foot and my right foot. It has began to affect my back and neck also.
One doctor said I had a "pinched nerve" and arthritis.
I have been given Ibuprofen and methocarbamol and a heating pad. It helps some, but not much. I am to see my doctor this June 22nd for father evaluation. Any suggestions? :O)
Peace to all... Jack
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