Rheumatoid arthritis is an inflammatory
disease that causes pain, swelling, stiffness, and loss of function in the joints. It has several special features that
make it different from other kinds of arthritis.
For example, rheumatoid arthritis generally occurs in a symmetrical pattern,
meaning that if one knee or hand is involved, the other one also is. The
disease often affects the wrist joints and
the finger joints closest to the hand. It can
also affect other parts of the body besides the joints. In addition, people
with rheumatoid arthritis may have fatigue, occasional fevers,
and a general sense of not feeling well.
Rheumatoid arthritis affects people differently. For some people, it lasts
only a few months or a year or two and goes away without causing any noticeable
damage. Other people have mild or moderate forms of the disease, with periods
of worsening symptoms, called flares, and periods in which they feel better,
called remissions. Still others have a severe form of the disease that is
active most of the time, lasts for many years or a lifetime, and leads to
serious joint damage and disability.
Features of Rheumatoid Arthritis
- Tender, warm, swollen joints
- Symmetrical pattern of affected joints
- Joint inflammation often affecting the wrist and finger joints
closest to the hand
- Joint inflammation sometimes affecting other joints, including
the neck, shoulders, elbows, hips, knees, ankles, and feet
- Fatigue, occasional fevers, a general sense of not feeling well
- Pain and stiffness lasting for more than 30 minutes in the morning
or after a long rest
- Symptoms that last for many years
- Variability of symptoms among people with the disease
Although rheumatoid arthritis can have serious effects on a person's life
and well-being, current treatment strategies – including pain-relieving
drugs and medications that slow joint damage, a balance between rest and
exercise, and patient education and support programs – allow most
people with the disease to lead active and productive lives. In recent years,
research has led to a new understanding of rheumatoid arthritis and has
increased the likelihood that, in time, researchers will find even better
ways to treat the disease.
How rheumatoid arthritis develops and progresses
A joint is a place where two bones meet. The ends of the bones are covered
by cartilage, which allows for easy movement
of the two bones. The joint is surrounded by a capsule that protects and
supports it. The joint capsule is lined with a type of tissue called synovium,
which produces synovial fluid, a
clear substance that lubricates and nourishes the cartilage and bones inside
the joint capsule.
|A joint (the place where two bones meet) is surrounded
by a capsule that protects and supports it. The joint capsule is lined
with a type of tissue called synovium, which produces synovial fluid
that lubricates and nourishes joint tissues. In rheumatoid arthritis,
the synovium becomes inflamed, causing warmth, redness, swelling,
and pain. As the disease progresses, the inflamed synovium invades
and damages the cartilage and bone of the joint. Surrounding muscles,
ligaments, and tendons become weakened. Rheumatoid arthritis also
can cause more generalized bone loss that may lead to osteoporosis (fragile bones that are prone to fracture).
Like many other rheumatic diseases, rheumatoid arthritis is an autoimmune
disease (auto means self), so-called because a person's immune
system, which normally helps protect the body from infection and disease,
attacks joint tissues for unknown reasons. White blood cells, the agents
of the immune system, travel to the synovium and cause inflammation (synovitis), characterized by warmth, redness, swelling, and pain –
typical symptoms of rheumatoid arthritis. During the inflammation process,
the normally thin synovium becomes thick and makes the joint swollen and
puffy to the touch.
As rheumatoid arthritis progresses, the inflamed synovium invades and destroys
the cartilage and bone within the joint. The surrounding muscles, ligaments, and tendons that support and stabilize the joint become weak and unable to work normally.
These effects lead to the pain and joint damage often seen in rheumatoid
arthritis. Researchers studying rheumatoid arthritis now believe that it
begins to damage bones during the first year or two that a person has the
disease, one reason why early diagnosis and treatment are so important.
Other parts of the body
Some people with rheumatoid arthritis also have symptoms in places other
than their joints. Many people with rheumatoid arthritis develop anemia,
or a decrease in the production of red blood cells. Other effects that occur
less often include neck pain and dry eyes and mouth. Very rarely, people
may have inflammation of the blood vessels, the lining of the lungs, or
the sac enclosing the heart.
Occurrence and impact of rheumatoid arthritis
Scientists estimate that about 1.3 million people, or about 0.6 percent
of the U.S. adult population, have rheumatoid arthritis. Interestingly,
some recent studies have suggested that although the number of new cases
of rheumatoid arthritis for older people is increasing, the overall number
of new cases may actually be going down.
Rheumatoid arthritis occurs in all races and ethnic groups. Although the
disease often begins in middle age and occurs with increased frequency in
older people, children and young adults also develop it. Like some other
forms of arthritis, rheumatoid arthritis occurs much more frequently in
women than in men. About two to three times as many women as men have the
By all measures, the financial and social impact of all types of arthritis,
including rheumatoid arthritis, is substantial, both for the Nation and
for individuals. From an economic standpoint, the medical and surgical treatment
for rheumatoid arthritis and the wages lost because of disability caused
by the disease add up to billions of dollars annually. Daily joint pain
is an inevitable consequence of the disease, and most patients also experience
some degree of depression, anxiety, and feelings of helplessness. For some
people, rheumatoid arthritis can interfere with normal daily activities,
limit job opportunities, or disrupt the joys and responsibilities of family
life. However, there are arthritis self-management programs that help people
cope with the pain and other effects of the disease and help them lead independent
and productive lives.
Searching for the causes of rheumatoid arthritis
Scientists still do not know exactly what causes the immune system to turn
against itself in rheumatoid arthritis, but research over the last few years
has begun to piece together the factors involved.
Genetic (inherited) factors: Scientists
have discovered that certain genes known to play a role in the immune
system are associated with a tendency to develop rheumatoid arthritis.
Some people with rheumatoid arthritis do not have these particular genes;
still others have these genes but never develop the disease. These somewhat
contradictory data suggest that a person's genetic makeup plays an important
role in determining if he or she will develop rheumatoid arthritis, but
it is not the only factor. What is clear, however, is that more than one
gene is involved in determining whether a person develops rheumatoid arthritis
and how severe the disease will become.
Even though all the answers are not known, one thing is certain: rheumatoid
arthritis develops as a result of an interaction of many factors. Researchers
are trying to understand these factors and how they work together.
Environmental factors: Many scientists think that something must
occur to trigger the disease process in people whose genetic makeup makes
them susceptible to rheumatoid arthritis. A viral or bacterial infection
appears likely, but the exact agent is not yet known. This does not mean
that rheumatoid arthritis is contagious: a person cannot catch it from
Other factors: Some scientists also think that a variety of hormonal
factors may be involved. Women are more likely to develop rheumatoid arthritis
than men, pregnancy may improve the disease, and the disease may flare
after a pregnancy. Breastfeeding may also aggravate the disease. Contraceptive
use may alter a person's likelihood of developing rheumatoid arthritis.
Scientists think that levels of the immune system molecules interleukin
12 (IL-12) and tumor necrosis factor-alpha (TNF-α) may change along
with the changing hormone levels seen in pregnant women. This change may
contribute to the swelling and tissue destruction seen in rheumatoid arthritis.
These hormones, or possibly deficiencies or changes in certain hormones,
may promote the development of rheumatoid arthritis in a genetically susceptible
person who has been exposed to a triggering agent from the environment.
Diagnosing and treating rheumatoid arthritis
Diagnosing and treating rheumatoid arthritis requires a team effort involving
the patient and several types of health care professionals. A person can
go to his or her family doctor or internist or to a rheumatologist. A rheumatologist
is a doctor who specializes in arthritis and other diseases of the joints,
bones, and muscles. As treatment progresses, other professionals often help.
These may include nurses, physical or occupational therapists, orthopaedic
surgeons, psychologists, and social workers.
Studies have shown that patients who are well informed and participate actively
in their own care have less pain and make fewer visits to the doctor than
do other patients with rheumatoid arthritis.
Patient education and arthritis self-management programs, as well as support
groups, help people to become better informed and to participate in their
own care. Self-management programs teach about rheumatoid arthritis and
its treatments, exercise and relaxation approaches, communication between
patients and health care providers, and problem solving. Research on these
programs has shown that they help people:
- understand the disease
- reduce their pain while remaining active
- cope physically, emotionally, and mentally
- feel greater control over the disease and build a sense of confidence
in the ability to function and lead full, active, and independent lives.
Rheumatoid arthritis can be difficult to diagnose in its early stages for
several reasons. First, there is no single test for the disease. In addition,
symptoms differ from person to person and can be more severe in some people
than in others. Also, symptoms can be similar to those of other types of
arthritis and joint conditions, and it may take some time for other conditions
to be ruled out. Finally, the full range of symptoms develops over time,
and only a few symptoms may be present in the early stages. As a result,
doctors use a variety of the following tools to diagnose the disease and
to rule out other conditions:
Medical history: This is the patient's
description of symptoms and when and how they began. Good communication
between patient and doctor is especially important here. For example,
the patient's description of pain, stiffness, and joint function and how
these change over time is critical to the doctor's initial assessment
of the disease and how it changes over time.
Physical examination: This includes the doctor's examination of
the joints, skin, reflexes, and muscle strength.
Laboratory tests: One common test is for rheumatoid factor, an
antibody that is present eventually in the blood of most people with rheumatoid
arthritis. (An antibody is a special protein made by the immune system
that normally helps fight foreign substances in the body.) Not all people
with rheumatoid arthritis test positive for rheumatoid factor, however,
especially early in the disease. Also, some people test positive for rheumatoid
factor, yet never develop the disease. Other common laboratory tests include
a white blood cell count, a blood test for anemia, and a test of the erythrocyte
sedimentation rate (often called the sed rate), which measures inflammation
in the body. C-reactive protein is another common test that measures disease
X-rays: X-rays are used
to determine the degree of joint destruction. They are not useful in the
early stages of rheumatoid arthritis before bone damage is evident, but
they can be used later to monitor the progression of the disease.
Doctors use a variety of approaches to treat rheumatoid arthritis. These
are used in different combinations and at different times during the course
of the disease and are chosen according to the patient's individual situation.
No matter what treatment the doctor and patient choose, however, the goals
are the same: to relieve pain, reduce inflammation, slow down or stop joint
damage, and improve the person's sense of well-being and ability to function.
Good communication between the patient and doctor is necessary for effective
treatment. Talking to the doctor can help ensure that exercise and pain
management programs are provided as needed, and that drugs are prescribed
appropriately. Talking to the doctor can also help people who are making
decisions about surgery.
Goals of Treatment
- Relieve pain
- Reduce inflammation
- Slow down or stop joint damage
- Improve a person's sense of well-being and ability to function
Current Treatment Approaches
- Slow down or stop joint damage
- Routine monitoring and ongoing care
Health behavior changes: Certain activities can
help improve a person's ability to function independently and maintain a
Rest and exercise: People with rheumatoid
arthritis need a good balance between rest and exercise, with more rest
when the disease is active and more exercise when it is not. Rest helps
to reduce active joint inflammation and pain and to fight fatigue. The
length of time for rest will vary from person to person, but in general,
shorter rest breaks every now and then are more helpful than long times
spent in bed.
Exercise is important for maintaining healthy and strong muscles, preserving
joint mobility, and maintaining flexibility. Exercise can also help people
sleep well, reduce pain, maintain a positive attitude, and lose weight.
Exercise programs should take into account the person's physical abilities,
limitations, and changing needs.
Joint care: Some people find using a splint for a short time around
a painful joint reduces pain and swelling by supporting the joint and
letting it rest. Splints are used mostly on wrists and hands, but also
on ankles and feet. A doctor or a physical or occupational therapist can
help a person choose a splint and make sure it fits properly. Other ways
to reduce stress on joints include self-help devices (for example, zipper
pullers, long-handled shoe horns); devices to help with getting on and
off chairs, toilet seats, and beds; and changes in the ways that a person
carries out daily activities.
Stress reduction: People with rheumatoid arthritis face emotional
challenges as well as physical ones. The emotions they feel because of
the disease – fear, anger, and frustration – combined with
any pain and physical limitations can increase their stress level. Although
there is no evidence that stress plays a role in causing rheumatoid arthritis,
it can make living with the disease difficult at times. Stress also may
affect the amount of pain a person feels. There are a number of successful
techniques for coping with stress. Regular rest periods can help, as can
relaxation, distraction, or visualization exercises. Exercise programs,
participation in support groups, and good communication with the health
care team are other ways to reduce stress.
Healthful diet: With the exception of several specific types of
oils, there is no scientific evidence that any specific food or nutrient
helps or harms people with rheumatoid arthritis. However, an overall nutritious
diet with enough – but not an excess of – calories, protein,
and calcium is important. Some people may need to be careful about drinking
alcoholic beverages because of the medications they take for rheumatoid
arthritis. Those taking methotrexate may need to avoid alcohol altogether
because one of the most serious long-term side effects of methotrexate
is liver damage.
Climate: Some people notice that their arthritis gets worse when
there is a sudden change in the weather. However, there is no evidence
that a specific climate can prevent or reduce the effects of rheumatoid
arthritis. Moving to a new place with a different climate usually does
not make a long-term difference in a person's rheumatoid arthritis.
Medications: Most people who have rheumatoid arthritis
take medications. Some medications are used only for pain relief; others
are used to reduce inflammation. Still others, often called disease-modifying
antirheumatic drugs (DMARDs), are used to try to slow the course of the
disease. The person's general condition, the current and predicted severity
of the illness, the length of time he or she will take the drug, and the
drug's effectiveness and potential side effects are important considerations
in prescribing drugs for rheumatoid arthritis. The table below shows currently
used rheumatoid arthritis medications, along with their uses and effects,
side effects, and monitoring requirements.
Biologic response modifiers are new drugs used for the treatment of rheumatoid
arthritis. They can help reduce inflammation and structural damage to the
joints by blocking the action of cytokines,
proteins of the body's immune system that trigger inflammation during normal
immune responses. Three of these drugs, etanercept (Enbrel), infliximab
(Remicade), and adalimumab (Humira), reduce inflammation by blocking the
reaction of TNF-a molecules. Another drug, called anakinra (Kineret), works
by blocking a protein called interleukin 1 (IL-1) that is seen in excess
in patients with rheumatoid arthritis.
For many years, doctors initially prescribed aspirin or other pain-relieving drugs for rheumatoid arthritis, as well as rest
and physical therapy. They usually prescribed more powerful drugs later
only if the disease worsened.
Today, however, many doctors have changed their approach, especially for
patients with severe, rapidly progressing rheumatoid arthritis. Studies
show that early treatment with more powerful drugs, and the use of drug
combinations instead of one medication alone, may be more effective in reducing
or preventing joint damage. Once the disease improves or is in remission,
the doctor may gradually reduce the dosage or prescribe a milder medication.
Surgery: Several types of surgery are available
to patients with severe joint damage. The primary purpose of these procedures
is to reduce pain, improve the affected joint's function, and improve the
patient's ability to perform daily activities. Surgery is not for everyone,
however, and the decision should be made only after careful consideration
by patient and doctor. Together they should discuss the patient's overall
health, the condition of the joint or tendon that will be operated on, and
the reason for, as well as the risks and benefits of, the surgical procedure.
Cost may be another factor. Commonly performed surgical procedures include
joint replacement, tendon reconstruction, and synovectomy.
Joint replacement: This is the most frequently
performed surgery for rheumatoid arthritis, and it is done primarily to
relieve pain and improve or preserve joint function. Artificial joints
are not always permanent and may eventually have to be replaced. This
may be an important consideration for young people.
Tendon reconstruction: Rheumatoid arthritis can damage and even
rupture tendons, the tissues that attach muscle to bone. This surgery,
which is used most frequently on the hands, reconstructs the damaged tendon
by attaching an intact tendon to it. This procedure can help to restore
hand function, especially if the tendon is completely ruptured.
Synovectomy: In this surgery, the doctor actually removes the inflamed
synovial tissue. Synovectomy by itself is seldom performed now because
not all of the tissue can be removed, and it eventually grows back. Synovectomy
is done as part of reconstructive surgery, especially tendon reconstruction.
Routine monitoring and ongoing care: Regular medical
care is important to monitor the course of the disease, determine the effectiveness
and any negative effects of medications, and change therapies as needed.
Monitoring typically includes regular visits to the doctor. It also may
include blood, urine, and other laboratory tests and X-rays. Millennium Labs offers medication monitoring and testing to find the best treatment for each individual.
People with rheumatoid arthritis may want to discuss preventing osteoporosis
with their doctors as part of their long-term, ongoing care. Osteoporosis
is a condition in which bones become weakened and fragile. Having rheumatoid
arthritis increases the risk of developing osteoporosis for both men and
women, particularly if a person takes corticosteroids. Such patients may
want to discuss with their doctors the potential benefits of calcium and
vitamin D supplements, hormone therapy, or other treatments for osteoporosis.
Alternative and complementary therapies: Special
diets, vitamin supplements, and other alternative approaches have been suggested
for treating rheumatoid arthritis. Although many of these approaches may
not be harmful in and of themselves, controlled scientific studies either
have not been conducted on them or have found no definite benefit to these
therapies. Some alternative or complementary approaches may help the patient
cope or reduce some of the stress associated with living with a chronic
illness. As with any therapy, patients should discuss the benefits and drawbacks
with their doctors before beginning an alternative or new type of therapy.
If the doctor feels the approach has value and will not be harmful, it can
be incorporated into a patient's treatment plan. However, it is important
not to neglect regular health care.
|Analgesics and Nonsteroidal
Anti-inflammatory Drugs (NSAIDs)
||Analgesics relieve pain; NSAIDs are a large class of medications useful against pain and inflammation.
A number of NSAIDs are available over the counter. More than a dozen
others – including a subclass called COX-2 inhibitors –
are available only with a prescription.
||NSAIDs can cause stomach irritation
or, less often, can affect kidney function. The longer a person uses
NSAIDs, the more likely he or she is to have side effects, ranging
from mild to serious. Many other drugs cannot be taken when a patient
is being treated with NSAIDs because they alter the way the body uses
or eliminates these other drugs. NSAIDs sometimes are associated with
serious gastrointestinal problems, including ulcers, bleeding, and
perforation of the stomach or intestine. People over age 65 and those
with any history of ulcers or gastrointestinal bleeding should use
NSAIDs with caution.
||Check with your health care provider
or pharmacist before you take NSAIDs. Before taking traditional NSAIDs,
let your provider know if you drink alcohol or use blood thinners
or if you have any of the following: sensitivity or allergy to aspirin
or similar drugs, kidney or liver disease, heart disease, high blood
pressure, asthma, or peptic ulcers.
||Nonprescription medications used to
relieve pain. Examples are aspirin-free Anacin, Excedrin caplets,
Panadol, Tylenol, and Tylenol Arthritis.
||Usually no side effects when taken as
||Not to be taken with alcohol or with
other products containing acetaminophen. Not to be used for more than
10 days unless directed by a physician.
|Aspirin is used to reduce pain, swelling,
and inflammation, allowing patients to move more easily and carry
out normal activities. It is generally part of early and ongoing therapy.
||Upset stomach; tendency to bruise easily;
ulcers, pain, or discomfort; diarrhea; headache; heartburn or indigestion; nausea or vomiting.
||Doctor monitoring is needed.
|NSAIDs help relieve pain within hours
of admin-istration in dosages available over-the-counter (available
for all three medications). They relieve pain and inflammation in
dosages available in prescription form (ibu-profen and ketoprofen).
It may take several days to reduce inflammation.
||For all traditional NSAIDs: Abdominal
or stomach cramps, pain, or discomfort; diarrhea; dizziness; drowsiness
or light-headedness; headache; heartburn or indigestion; peptic ulcers;
nausea or vomiting; possible kidney and liver damage (rare).
||For all traditional NSAIDs: Before taking
these drugs, let your doctor know if you drink alcohol or use blood
thinners or if you have or have had any of the following: sensitivity
or allergy to aspirin or similar drugs, kidney or liver disease, heart
disease, high blood pressure, asthma, or peptic ulcers.
||These are steroids given by mouth or
injection. They are used to relieve inflammation and reduce swelling,
redness, itching, and allergic reactions.
||Increased appetite, indigestion, nervousness,
||For all corticosteroids, let your doctor
know if you have one of the following: fungal infection, history of tuberculosis, underactive thyroid,
herpes simplex of the eye, high blood pressure, osteoporosis, or stomach
|These steroids are available in pill
form or as an injection into a joint. Improvements are seen in several
hours up to 24 hours after administration. There is potential for
serious side effects, especially at high doses. They are used for
severe flares and when the disease does not respond to NSAIDs and
||Osteoporosis, mood changes, fragile
skin, easy bruising, fluid retention, weight gain, muscle weakness,
onset or worsening of diabetes, cataracts, increased risk of infection,
hyper-tension (high blood pressure).
||Doctor monitoring for continued effectiveness
of medication and for side effects is needed.
||These are common arthritis medications.
They relieve painful, swollen joints and slow joint damage, and several
DMARDs may be used over the disease course. They take a few weeks
or months to have an effect, and may produce significant improvements
for many patients. Exactly how they work is still unknown.
||Side effects vary with each medicine.
DMARDs may increase risk of infection, hair loss, and kidney or liver
||Doctor monitoring allows the risk of
toxicities to be weighed against the potential benefits of individual
||This drug was first used in higher doses
in cancer chemotherapy and organ transplantation. It is used in patients
who have not responded to other drugs, and in combination therapy.
||Cough or hoarseness, fever or chills,
loss of appetite, lower back or side pain, nausea or vomiting, painful
or difficult urination, unusual tiredness or weakness.
||Before taking this drug, tell your doctor
if you use allopurinol or have kidney or liver disease. This drug
can reduce your ability to fight infection, so call your doctor immediately
if you develop chills, fever, or a cough. Regular blood and liver
function tests are needed.
||This medication was first used in organ
transplantation to prevent rejection. It is used in patients who have
not responded to other drugs.
||Bleeding, tender, or enlarged gums;
high blood pressure; increase in hair growth; kidney problems; trembling
and shaking of hands.
||Before taking this drug, tell your doctor
if you have one of the following: sensitivity to castor
oil (if receiving the drug by injection), liver or kidney disease,
active infection, or high blood pressure. Using this drug may make
you more susceptible to infection and certain cancers. Do not take
live vaccines while on this drug.
||It may take several months to notice
the benefits of this drug, which include reducing the signs and symptoms
of rheumatoid arthritis.
||Diarrhea, eye problems (rare), headache,
loss of appetite, nausea or vomiting, stomach cramps or pain.
||Doctor monitoring is important, particularly
if you have an allergy to any antimalarial drug or a retinal abnormality.
|Gold sodium thiomalate
||This was one of the first DMARDs used
to treat rheumatoid arthritis.
||Redness or soreness of tongue; swelling
or bleeding gums; skin rash or itching; ulcers or sores on lips, mouth,
or throat; irritation on tongue. Joint pain may occur for one or two
days after injection.
||Before taking this drug, tell your doctor
if you have any of the following: lupus, skin rash, kidney disease,
or colitis. Periodic urine and blood
tests are needed to check for side effects.
||This drug reduces signs and symptoms
and slows structural damage to joints caused by arthritis.
||Bloody or cloudy urine; congestion in
chest; cough; diarrhea; difficult, burning, or painful urination or
breathing; fever; hair loss; headache; heartburn; loss of appetite;
nausea and/or vomiting; skin rash; stomach pain; sneezing; and sore
||Before taking this medication, let your
doctor know if you have one of the following: active infection, liver
disease, known immune deficiency, renal insufficiency, or underlying
malignancy. You will need regular blood tests, including liver function
tests. Leflunomide must not be taken during pregnancy because it may
cause birth defects in humans.
||This drug can be taken by mouth or by
injection and results in rapid improvement (it usually takes 3-6 weeks
to begin working). It appears to be very effective, especially in
combination with infliximab or etanercept. In general, it produces
more favorable long-term responses compared with other DMARDs such
as sulfasalazine, gold sodium thiomalate, and hydroxychloroquine.
||Abdominal discomfort, chest pain, chills,
nausea, mouth sores, painful urination, sore throat, unusual tiredness
||Doctor monitoring is important, particularly
if you have an abnormal blood count, liver or lung disease, alcoholism,
immune-system deficiency, or active infection. Methotrexate must not
be taken during pregnancy because it may cause birth defects in humans.
||This drug works to reduce the signs
and symptoms of rheumatoid arthritis by suppressing the immune system.
||Abdominal pain, aching joints, diarrhea,
headache, sensitivity to sunlight, loss of appetite, nausea or vomiting,
||Doctor monitoring is important, particularly
if you are allergic to sulfa drugs or aspirin, or if you have a kidney,
liver, or blood disease.
|Biologic Response Modifiers
||These drugs selectively block parts
of the immune system called cytokines. Cytokines play a role in inflammation.
Long-term efficacy and safety are uncertain.
||Increased risk of infection, especially
tuberculosis. Increased risk of pneumonia,
and listeriosis (a foodborne illness caused by the bacterium Listeria
||It is important to avoid eating undercooked
foods (including unpasteurized cheeses, cold cuts, and hot dogs) because
undercooked food can cause listeriosis for patients taking biologic
|Tumor Necrosis Factor Inhibitors
|These medications are highly effective
for treating patients with an inadequate response to DMARDs. They
may be prescribed in combination with some DMARDs, particularly methotrexate.
Etanercept requires subcutaneous (beneath the skin) injections two
times per week. Infliximab is taken intravenously (IV) during a 2-hour
procedure. It is administered with methotrexate. Adalimumab requires
injections every 2 weeks. Long-term efficacy and safety are uncertain.
||Etanercept: Pain or burning
in throat; redness, itching, pain, and/or swelling at injection site;
runny or stuffy nose.
Infliximab: Abdominal pain, cough, dizziness, fainting,
headache, muscle pain, runny nose, shortness of breath, sore throat,
Adalimumab: Redness, rash, swelling, itching, bruising, sinus
infection, headache, nausea.
|Long-term efficacy and safety are uncertain.
Doctor monitoring is important, particularly if you have an active
infection, exposure to tuberculosis, or a central nervous system disorder.
Evaluation for tuberculosis is necessary before treatment begins.
|This medication requires daily injections.
Long-term efficacy and safety are uncertain.
||Redness, swelling, bruising, or pain
at the site of injection; head-ache; upset stomach; diarrhea; runny
nose; and stomach pain.
||Doctor monitoring is required.
• HEALTH AND DISEASE
Source: National Institute of Arthritis and Musculoskeletal
and Skin Diseases