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RA Treatments: DMARDs and TNF-Alpha Inhibitors

Introduction

Rheumatoid arthritis (RA) is a chronic autoimmune disorder. It causes your immune system to attack the healthy tissues in your joints, resulting in pain, swelling, and stiffness. Unlike osteoarthritis, which results from normal wear and tear as you age, RA can affect anyone at any age. No one knows exactly what causes it.

RA has no cure, but medications can help relieve symptoms. These medications include anti-inflammatory drugs, corticosteroids, and drugs that suppress the immune system. Some of the most effective drug treatments are disease modifying anti-rheumatic drugs (DMARDs), which include TNF-alpha inhibitors.

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DMARDs

DMARDs: Important in early treatment

DMARDs are medications that rheumatologists often prescribe right after a diagnosis of RA. Much of the permanent joint damage from RA happens in the first two years, so these drugs can make a big impact early on in the course of the disease.

DMARDs work by weakening your immune system. This action reduces RA’s attack on your joints to lessen the overall damage.

Examples of DMARDs include:

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DMARDs with painkillers

DMARDs with painkillers

The main downside to using DMARDs is that they’re slow to act. It can take several months to feel any pain relief from a DMARD. For this reason, rheumatologists often prescribe fast-acting painkillers such as corticosteroids or nonsteroidal anti-inflammatory drugs (NSAIDs) to take at the same time. These drugs can help reduce pain while you wait for the DMARD to take effect.

Examples of corticosteroids or NSAIDs that may be used with DMARDs include:

Corticosteroids

Over-the-counter NSAIDs

Prescription NSAIDs

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DMARDs and infections

DMARDs and infections

DMARDs affect your entire immune system. This means they put you at a greater risk of infections.

The most common infections that RA patients have are:

To help prevent infections, you should practice good hygiene, including washing your hands often and bathing daily or every other day. You should also stay away from people who are sick.

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TNF-alpha inhibitors

TNF-alpha inhibitors

Tumor necrosis factor alpha, or TNF alpha, is a substance that occurs naturally in your body. In RA, the immune system cells that attack the joints create higher levels of TNF alpha. These high levels cause pain and swelling. While several other factors add to RA’s damage in the joints, TNF alpha is a major player in the process.

Because TNF alpha is such a big problem in RA, TNF-alpha inhibitors are one of the most important types of DMARDs on the market right now.

There are five types of TNF-alpha inhibitors:

Natural TNF-alpha inhibitors
Natural kinds of TNF-alpha inhibitors can be found in supplements such as turmeric, milk thistle, and stinging nettle leaf extract. Be sure to talk to your rheumatologist before trying any alternative treatments.

These drugs are also called TNF-alpha blockers because they block the activity of TNF alpha. They reduce TNF alpha levels in your body to help decrease RA symptoms. They also begin to work more quickly than other DMARDs. They may start to take effect within two weeks to a month.

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Talk with your doctor

Talk with your doctor

Most people with RA respond well to TNF-alpha inhibitors and other DMARDs, but for some people, these options may not work at all. If they don’t work for you, tell your rheumatologist. They will likely prescribe a different TNF-alpha inhibitor as a next step, or they may suggest a different kind of DMARD altogether.

Be sure to update your rheumatologist on how you’re feeling and how well you think your medication is working. Together, you and your doctor can find an RA treatment plan that will work for you.

  • Can my diet affect my RA?
  • Yes. There are many foods that can help reduce inflammation in your body. If you want to try dietary changes to improve your RA symptoms, start by eating more foods that contain omega-3 fatty acids, antioxidants, and fiber, such as nuts, fish, berries, vegetables, and green tea. One good way to bring these foods into your daily routine is to follow the Mediterranean diet. For more information on this diet and other foods that may help ease RA symptoms, check out the anti-inflammatory diet for RA.

    - Healthline Medical Team
Article resources
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  • DMARDs overview. (n.d.). Retrieved from
  • Guo, Y., Wang, S., Wang, Y., & Zhu, T. (2016, July). Silymarin improved diet-induced liver damage and insulin resistance by decreasing inflammation in mice. Pharmaceutical Biology, 8, 1-6. Retrieved from
  • Rheumatoid arthritis treatment. (n.d.)Retrieved from 
  • What happens if your anti-TNF drug doesn’t work? (2015, December 1). Retrieved from 
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