Rheumatoid Arthritis – Treatment | Johns Hopkins

Rheumatoid Arthritis – Treatment | Johns Hopkins


(slow music) – When a patient is first diagnosed with rheumatoid arthritis,
one of their main questions is how are we going to treat this? How am I going to be feeling better? And there are several ways to
treat rheumatoid arthritis. We try to use medications that we call disease-modifying drugs
and what we mean by that is that they change the
course of the disease. They prevent erosions in the
joints and permanent damage. And these are key medications
to get started early in rheumatoid arthritis, so our patients don’t have that permanent
damage in their joints. Within this category of medications, these disease-modifying medications, there are two main subcategories. So there are conventional oral
disease-modifying medications and there are biologic
disease-modifying medications. (slow music) Often, people will start
first with the conventional oral medications to treat
their rheumatoid arthritis and so some examples of
these medications are Sulfasalazine, Methotrexate
and Leflunomide. And these medications work by modulating the immune system so
that it’s not as active damaging the joints as it normally is in rheumatoid arthritis. And these medications
have been used for decades in rheumatoid arthritis. They are generally well tolerated. There are some side effects
for the particular medications that need to be considered. We need to always watch
out for side effects when we’re starting any new medication. When you’re on these types of medications, the main thing to know
is that your blood work will need to be monitored regularly and this is to make sure
that the liver functions are normal and that the
blood counts all stay normal with these types of medications. There’s not a big
increased risk of infection with these types of medications. Some do not increase the
risk of infection at all, so that’s a plus for this
category of medications. So the fact that these
medications are oral or available by pills you take by mouth, that’s attractive to a lot of patients as opposed to injections or infusions like some of the biologic medication. So we’ll often start patients with a conventional disease-modifying drug before going to a biologic drug. And these medications, besides
having been around longer, end up being less expensive and often there’s less trouble with insurance of getting these medications
approved and paid for. (slow music) The other main class of medications to improve outcomes in
rheumatoid arthritis are biologic disease-modifying drugs. This class is ever expanding,
new drugs are coming out in the market, but the main categories are TNF inhibitors, drugs that
block an inflammatory protein called TNF. Abatacept, which is a drug
that helps prevent T cells from becoming too activated. Tocilizumab, which is a drug that blocks a proinflammatory protein that
causes inflammation, IL-6. Rituximab, which works on the B cells. (slow music) The biologic drugs,
the first ones approved were TNF inhibitors and
that’s about 20 years ago. So we’ve been using
some of these as long as two decades for the treatment
of rheumatoid arthritis. The TNF inhibitors are
only available in injection or infusion form. These medications work by turning down the immune responses that
are too active in RA. So turning the dial down
on your immune system. So as a result, one of the main things that we think about is
the risk of infection. Our immune system normally
is supposed to protect us from outside invaders, bacteria, viruses. And so when we start turning
down the immune system we do somewhat increase
the risk of infection. So before you would start a TNF inhibitor, your rheumatologist will
check you for hepatitis, viral hepatitis and also for tuberculosis to make sure that you don’t
have a chronic infection that could then come to the surface as a result of being
started on these drugs. And while you’re on these drugs, if any signs of infection
develop like fevers or productive cough, coughing
up stuff to suggest pneumonia, urinary tract symptoms, skin infections, anything of that sort,
these drugs will potentially be held while you’re
treated for those infections so that you can heal
and get back on track. That’s true in general for the biologics using the TNF inhibitors as an example. (slow music) These drug classes can often be combined, conventional oral disease-modifying drugs with biologic drugs. The oral drugs can be combined
together themselves as well. Sometimes biologic drugs
are used on their own. There are many different
treatment options. So when I have a patient who’s diagnosed with rheumatoid arthritis and they hear it’s a chronic disease
that we don’t yet cure, they’re often understandably
upset by this diagnosis. But I like to reassure people that in 2017 we have so many great treatment options for rheumatoid arthritis
and we can really manage the disease well and help
people achieve their goals and stay functional. (slow music) An infusion is a medication
that’s given directly into the vein. So to have an infusion, patient’s will go to an infusion center or a clinic. They’ll have an IV
started, so an IV catheter put into their vein,
usually into their arm and then the medication
will be given directly into the IV. The good thing about
infusion type medications is that compared to some medications, which have to be injected by the patient or a family member at home, they are going to a healthcare setting and they don’t have to do anything. They can just sit back
and let the nurses there take care of them and
give them the infusion. The downside of that is
that they must then go and make an appointment and
take time out of their day to have the infusions done
versus injection medications, which can be done at home by the patient or by family or friends. (slow music) Infusions are often
given with premedications to prevent any bad reactions. So patients will often
receive Tylenol and Benadryl and sometimes even steroids
before they get their infusion to make sure that
everything goes smoothly. Infusions often are given
more frequently up front and then spaced out. They are dosed by body weight, which is nice compared to
other types of medications, which are more one-size fits all dosing. So infusions are good options for treating rheumatoid
arthritis and other forms of autoimmune disease that
we see in rheumatology and to find out if that’s right for you, talk to your rheumatologist. (slow music)

Leave a Reply

Your email address will not be published. Required fields are marked *