Drugs used in the treatment of rheumatoid arthritis and certain other conditions caused by autoimmune disease
Antirheumatic drugs are used to treat rheumatoid arthritis, an autoimmune disease in which the immune system attacks the body’s own tissues, primarily the joints. Some antirheumatic drugs may also be used to treat other autoimmune disorders, such as systemic lupus erythematosus. Various types of drugs may be used in the treatment of rheumatoid arthritis, usually in combination with other treatments, such as physiotherapy.
The main drugs used to treat rheumatoid arthritis are known as disease-modifying antirheumatic drugs (DMARDs). These drugs modify the disease process itself by altering the activity of the body’s immune system, which leads to a reduction in symptoms such as pain and inflammation and can also limit further joint damage. Many of the DMARDs are immunosuppressants; the newer ones, often known simply as “biologicals”, reduce the level of a natural chemical called tumour necrosis factor-alpha (TNF-alpha), which plays a key role in causing inflammation in joints.
In addition to DMARDs, painkillers, non-steroidal anti-inflammatory drugs (NSAIDs), and corticosteroids may also be used during the initial treatment of rheumatoid arthritis or to control flare-ups of symptoms.
In most cases, treatment with DMARDs is started as soon as possible after rheumatoid arthritis has been diagnosed. Treatment with these drugs is started under specialist supervision, and before DMARDs are prescribed you will be given various tests to check whether you have any condition that might preclude the use of any particular drug. When DMARD treatment is started, you will probably be given a combination of drugs. Because it can take weeks, or even months, before DMARDs produce any noticeable effect, you may also be prescribed painkillers, NSAIDs, and/or corticosteroids to relieve symptoms in the interim.
It may be necessary to try various DMARDs to find the most suitable for you. If none of the standard DMARDs is found to be suitable, you may be prescribed one of the newer biological DMARDs. Once a suitable DMARD has been found, you will then probably need to take it indefinitely.
DMARDs are a diverse group of drugs and may therefore produce a wide range of side effects. Rarely, they may cause serious side effects, such as kidney, liver, blood, or eye problems, and for this reason people taking DMARDs are monitored regularly. Because DMARDs affect the immune system, they may not be suitable for some people with impaired immunity, due to HIV/AIDS, for example. Some DMARDs should not be used by women who are breast-feeding, and some may cause fetal abnormalities and should not be used during pregnancy.
If you are taking an antirheumatic drug, you should report any sign of infection, unusual bleeding, rash, sore throat, cough, or breathlessness to your doctor immediately.
From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.