When to Consider Combination Therapy for RA

Find out if this approach to treatment could help ease your rheumatoid arthritis symptoms.

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Modern rheumatoid arthritis care focuses on early, aggressive treatment—and one popular treatment option is therapy with disease-modifying antirheumatic drugs, or DMARDs. Many patients take a single DMARD to manage RA. Others take more than one DMARD, an approach called combination therapy.

Rheumatoid arthritis is a chronic condition that can severely damage joints, cause chronic pain and limit mobility and function. Therapy with DMARDs directly modifies processes in the body that may cause the disease. However, each drug affects different chemicals—such as tumor necrosis factor alpha or interleukin-1—so it's sometimes necessary to use more than one.

According to the Arthritis Foundation, methotrexate is the most common disease-modifying antirheumatic drug used in combination therapy for arthritis. It may be prescribed in conjunction with others medications such as etanercept and hydroxychloroquine.

Unlike non-steroidal anti-inflammatory drugs and analgesics—which for many years were the only options for treating rheumatoid arthritis, and only relieve pain—DMARDs can slow the progress of the disease and reduce joint damage. However, these drugs also carry the risk of side effects.

Risks associated with DMARDs

Disease-modifying antirheumatic drugs such as methotrexate can cause serious side effects, including:

  • Nausea and vomiting
  • Diarrhea
  • Liver toxicity and functional problems
  • Impaired blood cell production
  • Rashes
  • Mouth ulcers
  • High blood pressure
  • Fatigue
  • Birth defects
  • Kidney problems
  • Increased risk of cancer
  • Hair loss

Methotrexate and some other DMARDs also increase your risk of infections such as pneumonia. If you are taking a DMARD for rheumatoid arthritis, it's highly recommended that you get a pneumonia vaccination as well as the yearly flu shot.

Making the decision to try combination therapy

When you're first diagnosed with rheumatoid arthritis, discuss your treatment options with your healthcare provider. Other things to consider:

  • The costs. Find out how much the therapies cost and contact your insurance provider to find out what they will cover. If you're not covered, check out public programs such as Medicaid or Medicare.
  • The outcomes. Know what to expect from treatment. Ask your healthcare provider how DMARDs will affect your rheumatoid arthritis symptoms, including inflammation, stiffness and pain. Also, get an idea of how long it will take to see results.
  • Ways to reduce side effects. You may be able to limit some of the adverse reactions caused by combination therapy. For instance, you may need to abstain from alcohol when taking DMARDs. You may also need to take folic acid to counteract problems with blood cell formation. Discuss these precautions with your healthcare provider.

Although you may find the list of side effects of combination therapy worrisome, the effects of rheumatoid arthritis are also quite severe. Weigh your options carefully and work closely with your rheumatologist to keep your disease under control so you can enjoy better health and mobility in the future.

Medically reviewed in April 2020.

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