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Update on Drug Therapy for Rheumatoid Arthritis

In this report, the latest research findings for current drug therapies for rheumatoid arthritis (RA) are reviewed. Over the last 20 years, doctors have come to realize that RA must be treated early and aggressively.

New medications called disease-modifying antirheumatic drugs (DMARDs) have made it possible to halt the progression of this disease. Used in combination, joint damage can be prevented and even reversed. But significant side effects are possible. Patient must be monitored carefully.

Triple DMARD refers to the use of methotrexate (MTX), sulfasalazine (SSZ), and hydroxychloroquine. When combined together, results are much better than when used separately. Patients experience greater improvement in symptoms. Results are faster with this approach.

Studies are ongoing using different amounts and combinations of drugs. Doctors work with patients to find the most effective dosage to get the inflammatory process under control. High-dose DMARD may be needed to achieve this result. Then a maintenance dose is determined.

Some patients do not respond well to DMARDs. Other biologic agents are available and remain under study. These include tumor necrosis factors-alpha (TNF-a) antagonists and interleukin-1 receptor antagonist (IL-1RA).

Patients may recognize biologic agents by their names such as rituximab, etanercept, infliximab, adalimumab, anakinra, and abatacept. The goal is to find ways to stop the disease process at different places in the cycle. Researchers are trying to find drugs that work in both early and late disease.

References: Kevin Deane, MD, and Sterling West, MD. Increased Effectiveness in the Newer RA Therapies. In The Journal of Musculoskeletal Medicine. November 2007. Supplement. Vol. 24. No. 11. Pp. S11-S18.

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