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- Let's talk about treatment for RA.
There are many treatments available
for rheumatoid arthritis,
but not all treatments will work for all patients.
You must work closely with your rheumatology team
to get the right treatment for you.
Corticosteroids are sometimes started
in the very beginning when RA is suspected
and they are often started by your primary care doctor.
Now, corticosteroids may calm inflammation down,
but they have many side effects.
Your rheumatologist will confirm your diagnosis
and move on to something besides steroids.
Once you have your diagnosis,
your rheumatologist will start something called
a disease-modifying drug or DMARD.
And examples of those are methotrexate,
hydroxychloroquine, sulfasalazine and leflunomide.
The American College of Rheumatology recommends choosing
the DMARD that best fits how active your RA is.
Most often patients will begin with methotrexate.
Methotrexate's been highly successful
in decreasing RA symptoms.
Your rheumatologist will monitor your symptoms
and see how you're doing on methotrexate.
They can increase the dose
or they can add another medication to it
if you do not seem to be improving well.
You can find out more about methotrexate
and its side effects in another video.
The next group of drugs that I'm going to talk about
are called biologics.
A biologic drug is a protein and it's made in cells.
And these proteins need to be given as injections
under the skin or as an intravenous or IV infusion.
Biologics are made to specifically target
part of that cycle of inflammation.
The idea is that if we can break the cycle,
inflammation can be controlled.
The first group of biologics
are the tumor necrosis factor inhibitors, TNF.
TNF sends signals to produce more inflammation.
TNF inhibitors, the biologic drug can block
or stop that TNF activity.
TNF inhibitors were the first drugs
that were approved in the biologic category
for treatment of RA.
And they're usually the first drugs
your rheumatologist will prescribe.
They can be used with or without methotrexate,
but your insurance company may require
that a certain TNF inhibitor be used
before you can move to another biologic.
The brand names of TNF are Humira, Enbrel, Cimzia
Simponi, Simponi Aria and Remicade.
Humira, Enbrel, Simponi and Cimzia are given by an injection
under the skin every seven to 28 days depending on the drug.
And Simponi Aria and Remicade are given by an infusion
or the IV, every one to two months.
The next group of drugs
are called IL-6 inhibitors, interleukin-6.
and like TNF, IL-6 is associated
with the inflammation cycle.
The IL-6 inhibitors block the production of IL-6,
which can dampen or stop inflammation cycle.
The brand name of IL-6 inhibitors are Actemra and Kevzara.
Actemra is available as either an injection or infusion,
but Kevzara, is only available as an injection.
The next biologic is a T-cell co-stimulation modulator
called abatacept.
It works by blocking the amount of stimulation
that the T-cell with receives.
And by blocking the work of the T-cell,
the amount of inflammation decreases.
The brand name of the T-cell co-stimulation modulator
is Orencia.
Orencia can be given under the skin
as an injection or by an I.V.
The next biologic is rituximab.
Rituximab depletes or lowers B-cells.
And by lowering the number of B-cells,
part of your immune system can be turned off.
So rituximab is also used in other diseases
like vasculitis and lymphoma,
but the dose rheumatoid arthritis is different
than those used for other diseases.
Rituximab's brand name is Rituzan
and it's given by an infusion one day one
and then again, two weeks later,
and then not again for about six months
and you'll have to have blood work done to make sure
you're not eliminating too many B-cells.
And Rituzan's usually used when you've had
an unsuccessful result from using other biologics.
The next class of drugs are called Janus kinase inhibitors
or JAK inhibitors.
JAKs are responsible for signaling through receptors
for a number of the cytokines
and proteins involved in inflammation.
So JAK inhibitors can decrease
the activity of these cytokines.
JAK inhibitors are not biologic drugs,
but they are very similar in the way they treat RA
and in the side effects that they have.
JAK inhibitors, however are pills,
and they can be taken once or twice a day.
Currently there are three JAK inhibitors available,
Xeljanz, Rinvoq and Olumiant.
And we'll discuss the side effects of these medications
in the next video.
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