For most people, living with rheumatoid arthritis (RA) means living with multiple medications. Several medications have been shown to be effective at treating RA symptoms and some even slow progression of the disease. Medication can provide significant benefits for those living with RA; however, medication sometimes comes with a price—in the form of side effects.
Medication is often a non-negotiable component of RA treatment and there are several different types of medication used for different purposes. Not everyone with RA needs all of these types of medication, but some people do. Different people thrive on different treatment protocols.
There are four main types of drugs used to treat RA: disease-modifying antirheumatic drugs (DMARDs); biologics; steroids; and non-steroidal anti-inflammatory drugs (NSAIDs). You can learn more about these drugs and how they work in Treatment of Rheumatoid Arthritis.
If you’re taking RA medication, you may be facing side effects and nuisances associated with treatment.
Depending on your treatment protocol, you can expect to face a variety of side effects. The most common side effects that people with RA experience are:
- Hair loss
- Weight changes
- Gastrointestinal issues
- Mouth Sores
However, everyone’s experience with medication will vary. Furthermore, the type and severity of side effects vary depending on the type of medication.
DMARDs: DMARDs work by interfering with immune system activity that triggers damaging inflammation and they are often prescribed very early in treatment. DMARDs can take several weeks or months to start working, which can be frustrating when you are in pain. DMARDs can cause a variety of side effects, including rashes, increased sensitivity to sunlight, detached retinas, nausea, abnormal liver function, mouth sores, lung problems, changes in blood cell counts and more. DMARDs suppress the immune system, which means there is a greater susceptibility to infection while taking these drugs. If you are taking DMARDs, it is critical to watch for signs of infection, such as fever and chills, and report them to your doctor immediately.
NSAIDs: NSAIDs treat symptoms such as joint swelling, stiffness, and pain. Some NSAIDs can be extremely hard on the stomach, potentially causing life-threatening stomach bleeding. Other potential side effects include the risk of heart attacks and strokes.
Biologics: Biologic response modifiers work by targeting specific components of the immune system called cytokines, which play a critical role in triggering inflammation in rheumatoid arthritis. Biologics can significantly slow progression of the disease within a few weeks. These are promising drugs that have revolutionized the treatment of RA; however, they can carry a range of side effects, such as serious infections, heart problems, flare-ups of other chronic disease, and possibly even an increased risk of certain types of cancer.
Steroids: Steroids are powerful anti-inflammatory drugs that may be used on a short-term basis to reduce joint inflammation. Steroids can rapidly improve symptoms, but they come with their fair share of side effects, including bone loss, weight gain, cataracts, increased blood pressure, increased blood sugar levels, and more. The side effects associated with steroids such as prednisone can be frustrating, but for some people, the benefits far outweigh these side effects. Many people who take prednisone find that they experience headaches and insomnia and mood changes, including irritability and aggression.
Long-term use of steroids like prednisone can result in weight gain, fluid retention, acne, thin skin, and cataracts.
Communicating with Your Doctor about Side Effects
Many people with RA experience such a wide variety of side effects that they are afraid to talk with their doctor about them for fear of sounding like a hypochondriac. However, it is imperative to discuss your side effects with your doctor. Often it takes time for your doctor to find just the right medication or combination of medications for your symptom profile and disease status. By reporting your side effects, you provide valuable information that can help your doctor modify your treatment to meet your needs.
You do not have to suffer in silence. Side effects may be an inevitable part of living with medication; however, sometimes switching medications can help alleviate side effects. Be the squeaky wheel and continue to search for the right medication combination you can live with.
Tips for Managing Side Effects
Despite the advances in treatment and the variety of medications, you’re still likely to have to cope with some degree of side effects. Some people with RA have found benefit from the following tips:
- Eat something prior to taking medication
- Take medication at night
- Spread the dose of medication out over a period of time, if possible
- Use over-the-counter antacids to treat excess stomach acids associated with some medications
- Some people find that folic acid supplements provide relief from the side effects of methotrexate, such as hair loss, fatigue, gastrointestinal symptoms, and mouth sores
- Some people find that receiving medication via injection or infusion helped alleviate the side effects associated with oral medication.