Like any other chronic illness, there are choices when it comes to medication for rheumatoid arthritis. There are specific drugs that deal with the inflammation and autoimmune dysfunction, meds for pain, meds for the side effects of the meds. Some of the decisions are hit and miss, based on which drug works for you, because not all of them work for every person. We are lucky in this day and age because we can usually get RA under control much faster than even 20 years ago, enabling us to avoid some of the pain and joint deformity that used to be inevitable.
The best-known meds for RA are DMARDS, or Disease Modifying Anti-Rheumatic Drugs. Some of these have been used for a long time, like methotrexate, the standard RA drug. Methotrexate is a chemotherapy drug used to treat cancer, but is also given long term at a much lower dose to treat RA. It works very well in most patients, and many have no side effects.
Other people do have side effects, and they are what you think of with any chemo drug: nausea and other GI issues, hair thinning, and mouth sores. This drug must be taken with folic acid to decrease or avoid those side effects, otherwise you may not be able to tolerate it. If oral methotrexate gives you GI problems, you can get it in injectable form and inject it under your skin like diabetics do insulin. That can make a big difference in tolerating it.
Other DMARDS include gold salts (not used as much any more), Plaquenil (you must have annual eye exams while on this drug), Arava (this drug can cause serious liver problems and sun sensitivity), sulfasalazine, minocycline (an antibiotic), azathioprine, and cyclosporin. All of these medications carry a risk of adverse side effects, but not treating RA can be crippling or even fatal, so you must balance function with safety or risk vs. benefit.
Another class of medication commonly used to decrease rheumatic inflammation is corticosteroids. Prednisone is most often prescribed, sometimes in a pulse where the dose decreases rapidly and you go back off of it, or long-term low dose steroids. Steroids have many potential side effects, including Cushing’s disease, diabetes, osteoporosis, weight gain, and hypertension. Prednisone can be a necessary evil during RA flares, but it is recommended that you not take it long term if you can avoid it.
All of these medications suppress your immune system to some degree. This can raise your risk of infection, and can make common infections more dangerous for you. Always let your rheumatologist know if you are sick while taking immune-suppressant drugs. I have personally taken several of these drugs. While the potential side effects are scary, getting your life back thanks to modern medicine is wonderful.