Several of my patients have been diagnosed with rheumatoid arthritis, a frustrating condition in which the immune system begins to fight its own body as if it were a disease. In doing so, the body develops a severe, chronic inflammatory response in trying to heal it. This inflammation can flare in all the major joints of the body.
Traditional treatment options for RA have been DMARDs (disease modifying antirheumatic drugs), or SAARD (slow acting antirheumatic drugs), and have been fairly successful in treating early diagnosed RA. However, not everyone with RA responds to them and they do have side effects similar to those of NSAID (nonsteroidal anti-inflammatory drugs).
In the last 10 years, however, a new class of RA drugs has come on the scene, the “biologics”, or BRM’s (biologic response modifiers) and have shown greater success in people who have not done well on the traditional drugs. If you have RA, I’d like to share with you what I tell my own patients about the BRM class of RA drugs to help you manage your RA better.
Treating RA with Biologic-Type Drugs
Like my patients, if you watch television, you may have seen commercials for a few of the new biologic-type RA drugs, Enbrel, Humira, Orencia, and Simponi. You may have wanted to ask your doctor about the possibility of perhaps trying one of these RA treatments.
These RA drugs are actually created from human genes, proteins, and are designed to inhibit the inflammatory response that the immune system causes. These drugs were specifically created for those patients whose RA does not respond well to more traditional treatments and have been proven to slow progression of the disease. They differ from the older type drugs in that the biologics zero in on specific parts of the immune system instead of broadly treating the entire immune system, thereby lessening side effects.
Advantages to Taking BRM Type RA Drugs
Even though BRM’s will not cure RA, and those who take them still have symptoms of stiffness and pain, they have far less symptoms than those who do not take them, according to recent research conducted by one of the biologics manufacturer, Centocor Ortho Biotech, Inc. The drugs help improve quality of life, functioning, and ability to productively work, preventing much of the disability that accompanies RA.
Are There Side Effects/Disadvantages of Biologics?
As I tell my patients, whenever you take a chemically-based drug, there are likely some side effects, and this is true of the biologic-type RA drugs as well. However, there are not as many, or severe, as with the more traditional type RA drugs. The most common side effect is rash at the injection site but with any drug that suppresses the immune system, there is always the risk of other side effects. These include:
- Susceptibility to infections and other diseases developing
- Cannot receive vaccinations (flu, etc) while taking biologics
- Pre-existing health conditions like multiple sclerosis or congestive heart failure excludes their use. They could also aggravate an underlying case of tuberculosis. Everyone who wants to take a biologic-type RA should be tested for TB before taking them.
- Effects on unborn fetus not clearly known – pregnant women should use with caution.
- Must be taken by injection, or intravenous infusion. However, an oral biologic-RA drug is on the drawing table so perhaps one will be available soon.
- Biologics have to clear from system prior to surgery as open wounds with a depressed immune system can increase the risk for serious infection.
What You Can Do For Your RA
In addition to perhaps taking biologic response modifier-type RA drugs, there are several things you can do for yourself that will further help your symptoms such as:
- Regular aerobic exercise: 30 minutes, 5 days a week. Swimming is one of the best forms of exercise as it takes impact of joints. An elliptical machine is also good as it too takes the stress off of joints. Tai chi and yoga are also helpful.
- Regular sleep: We all need at least 6 hours of sleep per night, but if you have RA, you likely need more sleep. This also combats developing fibromyalgia which can accompany RA.
- Stress control: Stress can cause stiffness and pain in people who don’t have RA. In those who do, it can greatly aggravate or intensify existing symptoms. Find ways to decompress like meditation, exercise, or meeting with friends.
- Alternative treatments: I have often referred my RA patients for acupuncture, acupressure or reflexology (needle-free massage based acupuncture), tai chi exercise, hydrotherapy. These treatments can be done in addition to taking BRMs or DMARD/SAARD. In addition, herbal anti-inflammatories as white willow bark, bromelain, capsaicin, Boswellia, glucosamine, MSM, to name a few. Check with a pharmacist about possible drug interaction if you are taking prescription RA drugs.
- Diet: Many people with RA do better on gluten-free diets as wheat and oats can contribute to inflammation. Be sure to supplement with antioxidants.
RA is a condition that afflicts over 1.5 million Americans. Early diagnosis of it is crucial to getting the proper treatment for it before disabling joint damage begins. If you have symptoms of RA, severe pain and stiffness in the morning rising from bed, and/or after sitting, please contact your doctor and be evaluated for RA. Whatever drug treatment you and your doctor decide on, making the appropriate, natural lifestyle changes will also help you stay mobile.
Mark Rosenberg, M.D.