In regards to rheumatoid arthritis, early treatment is crucial. As a progressive disease with no known cure, it is imperative to start the process of curbing development, relieving inflammation and restricting joint damage from the beginning. Unfortunately, one of the key therapies used for this condition includes various side effects and isn’t effective for many patients.
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The drugs commonly used for patients with rheumatoid arthritis are known as disease-modifying antirheumatic drugs (DMARDs). These drugs work by suppressing the immune system. In individuals with this condition, it’s thought that the immune system malfunctions, misidentifying joint tissue as a harmful invader and assaulting it. Over time, inflammation and joint wear may result in disability.
There are numerous distinct kinds of DMARDs, each with its own set of side effects and dangers. Methotrexate is the most popular; it is related to adverse events which range from upset stomach and rash to liver toxicity and bone marrow toxicity (and birth defects when used by pregnant women). Another frequent medication, sulfasalazine, has its own long list, varying in seriousness from nausea and fatigue to liver damage, nerve/muscle issues and infections.
A third commonly-used DMARD, leflunomide, is associated with symptoms from diarrhea, runny nose and skin rash to signs of a severe reaction, such as troubled breathing, fever and irregular heartbeat. Despite dangers, the American College of Rheumatology guidelines for treating premature arthritis recommend using combination therapy – therapy with a few DMARDs in conjunction.
Because severe side effects are not common and the risk associated with the development of rheumatoid arthritis are severe, this is thought of as better than decreased medication therapy at the start. However, a new study from Belgium calls into question these recommendations, although more study is required to reevaluate current thinking around the state’s treatment.
In the analysis, 290 high-risk early rheumatic patients were randomized into one of three treatment groups: methotrexate along with sulfasalazine and a high initial dose of steroids (group 1); methotrexate with leflunomide plus a moderate first steroid dose (group 2); and methotrexate alone with a moderate first steroid dose (group 3). Researchers tracked patients for disease remission and adverse events following 16 weeks of therapy. All three treatment groups afforded similar remission rates – approximately 70 percent of individuals qualified for remission status (it must be noted that this rate is high in comparison to previous research). However, adverse event rates varied considerably.
In group 1 (combination sulfasalazine treatment ), 61.2% reported some adverse event, and 69.1% in group 2 (joint leflunomide treatment ) reported side effects. However, only 46.9percent in the single DMARD group did so. While almost half of patients in a treatment group reporting negative effects is nothing to sneeze at, the similar rates of remission compared to the various rates of side effects between groups stands in support of single DMARD use. Naturally, more research is needed to confirm these results. However, the results are promising to the many rheumatic patients that will be looking for the safest, most effective treatment route possible.