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Treating Rheumatoid Arthritis: “Non-biologic” drugs are a better first choice

Rheumatoid arthritis (RA) is a serious condition. The body’s immune system attacks the lining of the joints, and potentially, blood vessels and other organs. This causes swelling, stiffness, and pain.

RA cannot be cured, but it can be treated. Without treatment, RA can cause permanent damage to joints and internal organs, and disability.

How is RA treated?

The main drugs to treat RA are called DMARDS (disease-modifying anti-rheumatic drugs). These drugs help prevent damage to joints. They include both non-biologics and biologics.

Non-biologic RA drugs have been used for a long time. And over time, they have demonstrated their safety and effectiveness. Side effects are well described, affect only a proportion of individuals, and can be managed with your rheumatologist.

Biologics are a newer type of RA drug. However, in most cases, biologics should not be the first choice for treatment, according to the Canadian Rheumatology Association.

Non-biologics may be a safer choice.

Non-biologic RA drugs are better studied than the biologics. There is excellent data that many people will respond to non-biologics. Non-biologics include:

Biologics can have rare but serious side effects.

The following side effects are rare, but they can be serious or life-threatening:

Other side effects are less serious:

Minor infections, headache, and reactions at the injection site. People usually don’t change treatments because of these side effects.

When to take a biologic drug.

Most people should try at least one non-biologic RA drug for a period of at least three to four months before moving to a biologic. If there is no improvement, a rheumatologist may talk to you about trying biologics. If a non-biologic did not help you, there’s a good chance that a biologic will give relief.

People react to drugs differently. If one biologic does not help, another may be successful. But two biologic drugs should never be taken at the same time.

Tips to help with rheumatoid arthritis

RA affects other parts of the body as well as the joints. It is important to take care of yourself and pay attention to your health. You should:

Take your medication as prescribed. “Medications don’t work when they are not taken!” Contact your rheumatologist if you have any concerns regarding your medication – s/he is your “Arthritis Medical Expert”.

Stay active. Studies show that regular exercise reduces pain, increases energy, and improves sleep. Gentle exercises such as swimming or water aerobics are very helpful.

Get your bones checked. Talk to your doctor about getting a bone density test. RA can cause bone loss. Common RA drugs like prednisone and other corticosteroids may also cause bone loss.

Have your cholesterol checked. RA patients are more likely to have unhealthy cholesterol levels. Levels of good HDL cholesterol may be too low.

Stop smoking. Smoking has now been shown to contribute to the start of RA, and perhaps to its persistence.

Get vaccinated. RA and some of the drugs to treat it can increase the risk of infection. It is important to stay up to date on your shots. Be sure to get your flu and pneumonia vaccines. Talk to your doctor before you get a shot. It may be important to avoid “live” vaccines.