Types of Rheumatoid Arthritis Medications

Rheumatoid arthritis medications target the disease and its symptoms in different ways. Some slow down disease progression, while others reduce inflammation.

Rheumatoid arthritis (RA) medications alleviate symptoms and slow down or halt disease progression. While they cannot cure rheumatoid arthritis, early treatment greatly improves the chances of remission.

Medications attack RA and its symptoms from various angles. Some aim to slow down disease progression, while others target inflammation or pain.

The types of medications for rheumatoid arthritis include:

• Disease-modifying antirheumatic drugs (DMARDs):

• Nonbiologic DMARDs
• Biologic DMARDs

What is rheumatoid arthritis?

Rheumatoid arthritis is a progressive inflammatory autoimmune disease that affects synovium, the connective tissue lining and lubricating joints. It occurs when the immune system mistakenly attacks the body’s own tissues.

The immune system produces cytokines and chemokines, which cause inflammation, thickening of the synovium, and erosion of cartilage and bone in the joints. RA causes swelling, stiffness, pain, joint deformity, and organ dysfunctions.

RA is a systemic disease that initially affects smaller joints and can progress to larger joints and other organs such as the eyes, skin, heart, lungs, and kidneys.

The exact cause of rheumatoid arthritis is not known, but genetic predisposition plays a primary role. Juvenile rheumatoid arthritis involves multiple genes.

Other factors believed to trigger RA include:

• Infections: Reports of flulike disorders before the start of RA suggest possible involvement of viruses like Epstein-Barr and rubella. Bacterial material and antibodies to bacteria have been found in the synovial fluid of RA patients.
• Hormonal factors: RA is more prevalent in women, suggesting hormonal involvement. Pregnancy and hormonal changes from contraception can improve symptoms.
• Immunologic factors: Abnormal functioning of immune cells and cytokines leads to persistent inflammation.
• Environmental factors: Smoking, silica inhalation, gum disease, and gastrointestinal infections may be RA risk factors.

QUESTION

What are the types of rheumatoid arthritis medications?

Immediate treatment upon RA diagnosis is essential to prevent joint damage and organ complications.

The types of medications for rheumatoid arthritis include:

• Disease-modifying antirheumatic drugs (DMARDs):

• Nonbiologic DMARDs
• Biologic DMARDs

DMARDs are the primary drugs that target and modify the course of RA. Other medications treat pain and inflammation.

How do DMARDs for rheumatoid arthritis work?

DMARDs

Disease-modifying antirheumatic drugs are the primary treatment for rheumatoid arthritis. Early use can slow down or halt disease progression and prevent joint damage. DMARDs prevent the immune system from promoting inflammation.

It takes up to six months for DMARD therapy to be fully effective. Regular check-ups are important to monitor organ functions and adjust medications if needed.

Nonbiologic DMARDs

Nonbiologic DMARDs are synthetic proteins that suppress immune activity to slow down RA. Common nonbiologic DMARDs include:

• Methotrexate (Trexall, Otrexup)
• Azathioprine (Imuran)
• Auranofin (Ridaura)
• Chloroquine phosphate
• Cyclophosphamide (Cytoxan)
• Cyclosporine (Neoral)
• Hydroxychloroquine (Plaquenil)
• Leflunomide (Arava)
• Minocycline hydrochloride (Minocin)
• Mycophenolate mofetil (CellCept)
• Penicillamine (Cuprimine)
• Sulfasalazine (Azulfidine)

JAK inhibitors

JAK inhibitors block the activity of enzymes known as Janus kinases, which stimulate immune cells to produce inflammatory cytokines. JAK inhibitors used for RA treatment include:

• Tofacitinib citrate (Xeljanz)
• Baricitinib (Olumiant)
• Upadacitinib (Rinvoq)

Biologic DMARDs

Biologic DMARDs are genetically engineered monoclonal antibodies. They are more expensive and used as second-line treatment if nonbiologic drugs are not effective.

Biologic DMARDs may also be used in combination with nonbiologic DMARDs, typically methotrexate, when single-drug therapy is not enough. Two types of biologic DMARDs are used for treating RA:

TNF inhibitors

TNF inhibitors block the activity of tumor necrosis factor, a cytokine involved in immune cell activity and acute inflammation. TNF inhibitors used in RA treatment include:

• Etanercept (Enbrel)
• Etanercept-szzs (Erelzi)
• Infliximab (Remicade)
• Infliximab-abda (Renflexis)
• Infliximab-dyyb (Inflectra)
• Adalimumab (Humira)
• Adalimumab-atto (Amjevita)
• Certolizumab pegol (Cimzia)
• Golimumab (Simponi, Simponi Aria)

Non-TNF agents

Non-TNF agents inhibit other cytokines involved in inflammation. They are used when TNF inhibitors are not effective. Non-TNF agents used for RA include:

• Abatacept (Orencia)
• Anakinra (Kineret)
• Rituximab (Rituxan)
• Rituximab-abbs (Truxima)
• Rituximab-pvvr (Ruxience)
• Tocilizumab (Actemra)
• Sarilumab (Kevzara)
• Experimental DMARD therapies

Rheumatoid arthritis is a chronic disease that requires ongoing management. Researchers are investigating new medications targeting specific immune responses. Some medications currently in clinical trials for RA treatment include:

• Belimumab
• Ofatumumab
• Ocrelizumab
• Fostamatinib