Although there are a range of drugs that can treat rheumatoid arthritis (RA), they can all have significant side effects. “Some are common and some not so common,” says Diane Horowitz, MD, an associate professor of rheumatology at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York.
Whether you’re taking steroids or nonsteroidal anti-inflammatory drugs (NSAIDs) to control your symptoms or using disease-modifying antirheumatic drugs (DMARDs), including JAK inhibitors, to manage your RA condition, you and your doctor should discuss any potential side effects that can occur during your treatment. Here are eight RA medication side effects to be aware of.
1. NSAIDs and Stomach Problems
NSAIDs, which block the inflammation of RA, can be present in both prescription drugs and over-the-counter drugs like ibuprofen. The most common side effects are stomach problems like heartburn and belching, but you can minimize these risks by taking the medication with food.
“NSAIDs can cause cardiac, renal, and gastrointestinal issues, so patients should be mindful of this prior to starting them,” says Ryan Matthew, MD, a rheumatologist at the Clinic for Rheumatic Diseases in Northport, Alabama.
There is also increased toxicity risk, he adds, so it is important to have a conversation with your doctor about the safest use and dosage.
2. NSAIDs and Gastrointestinal Bleeding
NSAIDs can irritate the lining of your stomach, which can then lead to bleeding. (And unfortunately, taking the medication with food might not help.)
“If you are frequently taking over-the-counter NSAIDs, you need to let your doctor know,” says Dr. Horowitz. Your provider might be able to give you a medication that will reduce your risk of bleeding while taking NSAIDs. And in the meantime, you can further cut your risk by avoiding alcohol.
3. Steroids and Toxicity
Steroids in RA management get symptoms under control quickly. But they may also cause high blood pressure, weight gain, high blood sugar, and decreased bone health.
“Guidelines are shifting away from frequent steroid use given the long-term toxicity and increased infection risk associated with steroids,” says Dr. Matthew.
4. Methotrexate Fatigue
Folic acid, a B vitamin, taken along with methotrexate, may help limit these side effects, Horowitz says.
5. Methotrexate Liver Damage
“Liver function should be checked prior to initiation of methotrexate and then again two to three weeks after starting the medication,” says Matthew. After that, the rheumatologist will recheck lab work every three months if patients are on a stable dose. The risks and benefits should be discussed thoroughly with your doctor beforehand.
6. Hydroxychloroquine and Eye Damage
Combining methotrexate with two other DMARDs — sulfasalazine and hydroxychloroquine — may be an option if methotrexate alone isn’t enough to achieve good RA management.
Although you should have an eye exam by an eye specialist within six months of starting this drug (and be rechecked at regular intervals recommended by your rheumatologist), you should tell your doctor immediately if you start having eye pain, sensitivity to light, or vision changes, says Horowitz.
7. Biologic Drugs and Infection
Your doctor may recommend biologic drugs if older DMARDs are not helping you manage the symptoms of RA. “The biggest worry with biologics is an increased risk of infection,” Horowitz says.
Before you begin treatment with biologic drugs, your doctor is likely to test you for tuberculosis and hepatitis, because biologics weaken your immune system and could reactivate those infections. And if you have another active infection, your doctor may want to wait until you recover.
Once you begin using biologics, wash your hands frequently, avoid people who are sick, and tell your doctor if you develop a cough, fever, or symptoms of a cold.
“There is a small theoretical risk of cancer, psoriasis, and heart failure with certain biologic treatments, but for most patients this small risk is outweighed by the potential benefits of biologic treatment,” says Matthew.
8. JAK Inhibitors, Infection Risk, and Heart-Related Problems
The Takeaway
- Medications for rheumatoid arthritis all have potential side effects, some more serious than others.
- Depending on the drug, side effects or complications can include digestive issues, infection, liver or eye damage, cardiovascular problems, and fatigue.
- Your best defense against all RA medication side effects is to be informed and follow all your doctor’s instructions carefully. Your rheumatologist can assess your particular situation to make sure the benefits of controlling your RA outweigh any possible risks.
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