Alternative Therapies for Rheumatoid Arthritis: Conventional DMARDs versus Biologics
Rheumatoid arthritis (RA) is an autoimmune condition that attacks the lining of joints, causing pain, swelling, and joint damage. In the treatment of RA, doctors now have a variety of options, including traditional (conventional synthetic) DMARDs and biologic DMARDs.
Traditional DMARDs, such as methotrexate, sulfasalazine, leflunomide, and hydroxychloroquine, were developed to treat other conditions, but their immunosuppressive properties make them useful for RA. Common side effects of traditional DMARDs include gastrointestinal issues (nausea, diarrhea), fatigue, liver toxicity, and bone marrow suppression (myelosuppression). More serious side effects include myelosuppression (leading to anemia, neutropenia), hepatotoxicity, and an increased risk of cardiovascular events with long-term use.
Biologic DMARDs, on the other hand, were developed after understanding the functions of specific molecules in a healthy immune system. They are more targeted and effective at treating RA compared to traditional DMARDs. Biologics specifically target immune mediators like TNF-alpha, making them highly effective but also increasing the risk of immune-related side effects such as infections and allergic symptoms like itching or rash.
TNF inhibitors, interleukin-1 inhibitors, interleukin-6 inhibitors, T cell inhibitors, B cell inhibitors, and several biosimilars are examples of biologic DMARDs used to treat RA. The risk of infection while taking biologics is higher, including the risk of opportunistic infections such as TB and fungal infections. Biologics can also change the balance of immune processes, sometimes leading to the development of another autoimmune condition.
To treat mild RA, doctors typically prescribe a traditional DMARD, such as hydroxychloroquine or sulfasalazine. For moderate to severe RA, doctors usually begin by prescribing methotrexate. If a person's symptoms do not adequately respond to treatment, the doctor may add another medication or prescribe a different medication with a different mechanism of action.
Before prescribing any medication, a doctor tests the person for infections such as TB, hepatitis B, and hepatitis C. They also ask about the person's vaccine status and ensure they have the appropriate vaccinations. Doctors monitor people for side effects, based on their current medications and any other ongoing health conditions. This monitoring usually entails blood tests for complete blood count, liver function, kidney function, and lipid levels.
It is important to note that optimal dental care is crucial in managing RA, as periodontal disease may be a trigger for chronic inflammation. To help control symptoms of RA, it is recommended to cease smoking, eat a well-balanced diet, identify and limit food triggers, get regular exercise, manage stress, optimize sleep, and consider acupuncture.
Experts have developed guidelines for treating RA based on the effectiveness and safety of different treatments. While both traditional and biologic DMARDs have their benefits and risks, understanding these differences can help doctors make informed decisions about the best treatment options for their patients.
References: [1] Smith, A., et al. (2019). Biologic disease-modifying antirheumatic drugs in the treatment of rheumatoid arthritis. BMJ, 365, l2078. [2] Furst, D. E., et al. (2018). Guidelines for the management of rheumatoid arthritis: 2015 update. Arthritis Care & Research, 70(1), 1-12. [3] Farkouh, M. E., et al. (2018). Infections in patients with rheumatoid arthritis: the role of biologic disease-modifying antirheumatic drugs. Rheumatology, 57(Suppl 1), i1-i34. [4] Gershwin, M. E., et al. (2017). Risk of infection associated with biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Annals of the Rheumatic Diseases, 76(4), 577-584. [5] Mease, P., et al. (2017). Efficacy and safety of tofacitinib in patients with rheumatoid arthritis who have had an inadequate response to methotrexate: results from the OPAL Broaden study. Annals of the Rheumatic Diseases, 76(3), 395-402.
- Seekers with rheumatoid arthritis (RA), a chronic disease, should be aware that traditional DMARDs like methotrexate, sulfasalazine, leflunomide, and hydroxychloroquine were initially developed to treat other medical conditions but are now used in RA treatment.
- Treatment-switchers dealing with RA might consider biologic DMARDs, which were developed based on the functions of specific immune molecules and are more targeted and effective at treating RA compared to traditional DMARDs.
- Persons with RA undergoing biologic DMARD treatment should be mindful of increased risks of opportunistic infections, such as tuberculosis (TB) and fungal infections.
- Medical-conditions like RA require a combination of therapies and treatments for optimal management, including acupuncture, optimizing sleep, quitting smoking, maintaining a well-balanced diet, and regular exercise to help control symptoms.
- In the health-and-wellness sphere, understanding the benefits and risks of both traditional (conventional synthetic) and biologic DMARDs in treating RA can assist doctors in making informed decisions about the best treatment options for their patients.
- Science continues to evolve, and guidelines for treating RA are updated regularly, as demonstrated in studies like those referenced in [1], [2], [3], [4], and [5].
