RA treatment can help slow the progression of the disease and relieve symptoms. But each medication comes with certain risks and side effects.
Rheumatoid arthritis (RA) is an autoimmune, inflammatory type of arthritis. It occurs when your immune system mistakenly attacks your body’s joints and tissues, leading to symptoms like joint pain, swelling, and stiffness.
While there’s no cure for RA, treatments can relieve symptoms. Early diagnosis and treatment can help prevent the progression of RA and improve your quality of life.
Each type of RA treatment comes with side effects. Knowing what to expect can help you prepare to manage side effects, know when to talk with your doctor, and live your best life with RA.
Over-the-counter pain relievers like ibuprofen or naproxen can treat RA symptoms. These medications are called nonsteroidal anti-inflammatory drugs (NSAIDs). They may offer some relief, but they do not slow or stop the progression of RA. So, they’re often used in combination with disease-modifying RA medications.
Side effects of NSAIDs include:
- upset stomach
- increased risk of heart attack, stroke, and heart failure
- decreased kidney function
- severe allergic reaction
- increased bruising
- interactions with alcohol or other medications
In rare cases, NSAIDs may cause serious ulcers and bleeding in the stomach. Celecoxib (Celebrex) is a prescription NSAID that provides similar anti-inflammatory relief and is less likely to cause stomach problems.
Corticosteroids like prednisone and hydrocortisone are potent anti-inflammatory drugs. They work quickly to reduce RA-related inflammation in the body. They can be taken orally, topically, or as an injection or infusion.
Doctors often only prescribe these drugs short term, either until other disease-modifying drugs start to take effect or to calm a flare. That’s because corticosteroids have many potential risks and side effects, most notably:
- bone loss and increased risk of fracture
- eye changes such as cataracts or glaucoma
- high blood pressure
- high blood sugar
- increased risk of infection
- mood changes
- reduced response to stress
- skin changes
- weight gain
Corticosteroids can also cause:
- breathing difficulties
- dizziness
- headache
- irregular heart rate
- numbness or tingling in your arms and legs
- pounding in your ears
- trouble with activities like using the bathroom, walking, or thinking
If your doctor prescribes a corticosteroid, use it exactly as directed and follow their recommendations for tapering off.
You may experience side effects long after you stop taking corticosteroids, so be sure to talk with your doctor about any issues that come up.
Traditional disease-modifying anti-rheumatic drugs (DMARDs) work by suppressing the immune system to help slow or stop the progression of RA, which in turn helps alleviate RA symptoms.
- upset stomach
- increased risk of infection
- skin rash
- bone marrow suppression
- increased risk of liver issues
Side effects unique to methotrexate include an increased risk of:
- alopecia
- lung disease
- folic acid deficiency
- cirrhosis
Leflunomide can also increase the risk of:
- alopecia
- high blood pressure
- peripheral neuropathy
- weight loss
Stomach upset is very common with sulfasalazine. This drug can also increase the risk of a serious and potentially life threatening side effect called drug reaction with eosinophilia and systemic symptoms, also known as DRESS syndrome.
Biologics are a newer type of DMARD that targets certain components of the immune system to help slow disease progression and improve RA symptoms.
Options include:
- tumor necrosis factor-a (TNF) inhibitors
- B-cell inhibitors
- interleukin inhibitors
- selective co-stimulation modulators
They’re available as injections or infusions.
Most notably, all biologics come with an increased risk of infection and certain types of cancers.
However, each type of drug comes with specific risks and side effects.
TNF inhibitors come with an increased risk of:
- infections, including tuberculosis (TB) or fungal infections
- specific types of cancer, including skin cancer and lymphoma
- heart failure or multiple sclerosis (if taking the drug adalimumab)
- developing a resistance to the drug (but using it in combination with methotrexate may reduce this risk)
B-cell inhibitors come with an increased risk of:
- infections, including serious or fatal infections
- infusion reactions
- certain types of cancer
- reactivation of the hepatitis B virus, which can lead to a severe brain infection
These drugs should be avoided if you’re pregnant or trying to become pregnant.
Interleukin inhibitors can come with an increased risk of:
- infections, including opportunistic infections such as TB, herpes zoster, or toxoplasmosis
- certain types of cancer
While selective co-stimulation modulators have the same risk of infection and cancer as other biologic drugs, they come with fewer hospitalizations for serious infections.
JAK inhibitors are the newest type of disease-modifying treatment for RA. These oral drugs target the overactive immune system response at the cellular level to help prevent disease progression and improve symptoms.
All JAK inhibitors come with a black box warning for an increased risk of:
- certain cancers
- venous thromboembolism
- major adverse cardiovascular events, like heart attack and stroke
Other more common types of side effects from JAK inhibitors include:
- upper respiratory infections
- lung infections like pneumonia or bronchitis
- flu
- bladder infections
- shingles
- high cholesterol
- increased levels of liver enzymes or muscle enzymes in the blood
However, in many cases, the benefits of these drugs outweigh the risks. It’s important to work closely with your doctor to find the right treatment regimen for you.
Various medications are available for treating RA. Each comes with its own list of potential risks and side effects.
Work with your doctor to weigh the risks and benefits of your RA treatment options. If you start experiencing side effects that are disruptive to your daily life, be sure to tell your doctor. Changing your treatment regimen may help.