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Rheumatrex (methotrexate)

If your joint disease takes an aggressive turn, and you are not responding all that well to NSAIDs, methotrexate is the next logical step. Its toxic effects appear to be lessened when it is given in low doses on a once-weekly basis. In most patients its benefits will outweigh its risks. People with RA are more likely to continue methotrexate than they are any of the other second-line drugs. But it can cause problems, including nausea, abdominal pain, diarea, and vomiting. Liver failure can occur in * very small percentage of patients, especially the very old and those who have been on the drug for long periods.

Plaquenil (hydroxychloroquine)

This drug, which is also used to treat malaria,used for people with slowly progressive RA it is less toxic than most of the other drugs used for RA and therefore is favored as and second-line agent.

Corticosteroids – Rheumatrex, Plaquenil, Zoatrix for chemotherapy

Prednisone

Steroids, as they are usually called, reduce inflammation, swelling, and joint pain in people with RA. Their use is somewhat controversial, because they also have some very undesirable side effects when used for prolonged periods.

The way to maximize the benefits of steroids and reduce the toxic side effects is to have your doctor prescribe them at the lowest dose possible (5 to 10 mg per day). They are especially useful in older people, as an alternative to the even more toxic second-line drugs, and in younger people to help control flare-ups. Side effects include weight gain, bone wasting, cataracts, risk of infection, elevated blood pressure, ulcers, bleeding, and skin changes.

Azulfidine (sulfasalazine)

This drug has shown increasing promise for treatment of RA. In one study, when used in combination with methotrexate and hydroxychloroquine in patients who had shown a poor response to other medications, people with severe RA showed significant improvement.

Zoatrix (capsaicin)

This drug is made from a substance found in hot peppers. Many people have found that continued use of this cream can improve joint pain.

Aspirin

Aspirin was one of the original treatments for RA. I no longer recommend it because multiple daily doses are required, which can be very inconvenient for RA sufferers, who frequently have to take many other pills. In addition, the dose of aspirin required to reduce inflammation is high enough to cause stomach irritation and other gastrointestinal complications in a significant percentage of people. NSAIDs are preferred over aspirin.

Depen (penicillamine)

Depen is not as effective as the second-line drugs in “Optimal” and “Recommended/’ This medication can cause a rash, itching, altered taste sensations, and blood count problems.

AVOID IF POSSIBLE (Not Recommended)

Sandimmune (cyclosporine)

This drug should be avoided if possible. It can cause serious kidney problems and have toxic effects on the liver as well. Its use is experimental and should be reserved for people in whom all else has failed.

Corticosteroids – Rheumatrex, Plaquenil, Zoatrix for chemotherapy

Myochrysine (gold sodium thiomalate) Gold by injection should be avoided because of its toxic effects on the kidneys. Gold taken by mouth (orally) appears to be less toxic but is also less effective than the drugs mentioned in the “Optimal” and “Recommended” categories.

Imuran (azathioprine)

This cancer chemotherapy drug can affect the immune system and cause liver problems It may predispose people to getting a type of cancer called lymphoma.

Chlorambucil This chemotherapy drug can compromise the immune system and lead to an increased nsk of infections and certain cancers.

Cyclophosphamide This chemotherapy drug can compromise the immune system and lead to an increased nsk of infections and certain cancers.

Meclomen (meclofenamate)

This NSAID is much more likely to produce severe diarrhea than other drugs in this class, and therefore should be avoided.

Feldene (piroxicam)

This is one of the best pain relievers and antiinflammatory drugs among the NSAIDs. It has been embroiled in controversy over its relative risk for causing gastrointestinal bleeding in elderly people with chronic arthritis. No long-term study has convincingly pmven that piroxicam does produce a higher risk of bleeding. Some studies suggest it does, others say no. Geriatric experts tend to avoid this NSAID. Its use as a first-line drug was more attractive a few years ago, when it was the only once-daily NSAID available. Now that other options (Daypro and Relafen), with equal convenience, are approved, Feldene’s advantages are less convincing.




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