Out of the possible medications for rheumatoid arthritis treatment, what makes the DMARDs class of medications effective? In this episode, Dr. Ariel Teitel, a Rheumatologist at NYU Langone Medical Center, explains what the DMARDs are, how they are used, and why they are so effective at treating rheumatoid arthritis.
Dr. Teitel: There is no cure for rheumatoid arthritis, but the medications that are available nowadays are so excellent, that basically many people who have it, feel like they don't have it anymore. I mean, this is real incredible, this wasn't the case many years ago. It is important that rheumatoid arthritis treatment be an informed decision made between the patient and their doctor. Rheumatoid arthritis is a lifelong disease usually treated with a combination of rest, physical or occupational therapy, weight loss, and medications. Medications used to help slow down the progression and inflammation of rheumatoid arthritis are called the Disease Modifying Antirheumatic Drugs, or DMARDs. Clinical studies show that early treatment with DMARDs, typically within the first 12 weeks of diagnosis, may improve a patients outcome. DMARDs are classified as non-biologic and biologic response modifiers. Methotrexate is often the non-biologic DMARD of first choice in rheumatoid arthritis. The Methotrexate, is still used, and is still an important part of the treatment, and still helps the newer drugs work better in fact. They do have immunologatory effects, or immune control effects say. In rheumatoid arthritis, methotrexate is thought to work by blocking proteins that can lead to inflammation. Results may be seen as early as 3 weeks. Methotrexate may be given orally or by injection. Many biologic DMARDs have been approved by the FDA for the treatment of rheumatoid arthritis. Examples of biologic DMARDs include: Humira, a TNF antagonist; Kineret, an interleukin-1 receptor antagonist; and Rituxan, a monoclonal antibody to B cell receptors. The biologic DMARDs have been shown to slow disease progression when non-biologic agents fail. Many of the DMARDs may also be used in combination for added effectiveness when a single agent fails. I think it's great for patients to be educated, and to look up whatever they want about medications, but I would recommend making sure that you go to authoritative places, and read careful information, and again, look at the actual risk, is it 1 in 10, 1 in 100, or 1 in 1000; that's a big difference.
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