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Long term medication options for Rheumatoid Arthritis (Part 3)

Posted by Eamonn Brady on

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar.

If you have any health questions e-mail them to

This is the final of three articles on the subject of rheumatoid arthritis (RA). This week I discuss used for longer term control of RA. Disease modifying anti-rheumatic drugs (DMARDs) are core to treatment as they slow down or stop the progression of the condition and prevent joint deformities. They allow people suffering from RA enjoy a normal life.

Disease-modifying antirheumatic drugs (DMARDs)

DMARDs help to ease symptoms and slow down the progression of RA. The earlier a DMARD is started, the more effective it will be. They must be started by a consultant rheumatologist; therefore, it is important to seek treatment with a rheumatologist early if showing signs of RA.

The most commonly used DMARDs include methotrexate, hydroxychloroquine and sulfasalazine. Methotrexate is often the first choice DMARD for RA. It can be taken on its own or in combination with another DMARD. The most common side effects of methotrexate are sickness, diarrhoea, mouth ulcers, hair loss or hair thinning, and rashes on the skin.

Regular blood tests to monitor blood count and liver are required as methotrexate can cause potentially very serious liver and blood count problems. Most people tolerate methotrexate well and more than 50% of patients take it for at least five years.

Methotrexate improves symptoms by 50-80%, slows the rate of joint destruction and improves function and quality of life. Doses of methotrexate up to 20mg weekly may be needed. Injection form may be considered in severe acute RA, if oral treatment is ineffective or in those unable to tolerate oral methotrexate. It takes 6 to 12 weeks for methotrexate to start working.

Methotrexate may also be combined with biological treatments. It is very important to emphasise that methotrxate is a weekly dose.

Sulfasalazinehas a slow onset of effect (1 - 3 months). Patients may need to discontinue long-term treatment of sulfasalazine due to gastrointestinal complaints.

Hydroxychloroquinetakes several weeks to exert its effect. It has been reported to be less effective than the other DMARDs but is well-tolerated; therefore it may be useful in mild disease or in combination therapy. However it can cause eye damage so regular eye checks are needed.


Azathiaprine (Imuran®)and Ciclosporin (Neoral®)tend to be reserved for severe RA, when other DMARDs are ineffective or inappropriate. They tend to be last line as they have many potential serious side effects, mainly due to their suppression of the immune system.

Biological treatments

Biological treatments are a newer form of treatment for RA. They include TNF-alpha inhibitors (etanercept , infliximab, adalimumab and certolizumab), rituximab and tocilizumab. Etanercept (Enbrel®) and adalimumab (Humira®) are most commonly prescribed biological treatments for RA in Ireland. In general, biological agents are reserved for patients with moderate to severe active RA where conventional DMARDs have failed.

They are usually taken in combination with methotrexate or sometimes with another DMARD. They work by stopping particular chemicals in the blood from activating the immune system to attack the lining of joints. They are given by subcutaneous injection. Side effects from biological treatments are usually mild and include skin reactions at the site of injection, infections, nausea, fever and headaches.

Upcoming Rheumatoid Arthritis Talk

Whelehans Pharmacy in conjunction with Arthritis Ireland (Westmeath Branch) is hosting a Rheumatoid Arthritis Information evening on Tuesday April 28th at 7pm in the Greville Arms Hotel in Mullingar.

Admission is free. Speakers on the night will include Aoife Weller from Mullingar who suffers from Rheumatoid Arthritis; Nutritionist Aisling Murray BSc (nutrition); Chartered Physiotherapist Sinead Brogan MISCPand pharmacist Eamonn Brady MPSI. Call the Whelehans Pharmacy at 04493 34591 for more information or to book a place.

This article is shortened to fit within Newspaper space limits. More detailed information and leaflets is available in Whelehans

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