Rx insights on Rheumatoid Arthritis

Rx insights on Rheumatoid Arthritis 

Rx Insights: Rheumatoid Arthritis

A practical drug-focused guide for clinicians and students. Read for therapy choices, monitoring, interactions, and clinical tips.

What it is

You have a chronic autoimmune disease in which the immune system attacks the synovial lining of joints. You get pain, swelling, stiffness, and progressive deformity without treatment.

Core pathology

• Persistent synovial inflammation
• Cartilage and bone destruction
• Systemic involvement, including eyes, lungs, heart

Drug groups used

NSAIDs

Relieve pain and stiffness. No effect on disease progression. Examples: ibuprofen, naproxen, etoricoxib.

Corticosteroids

Rapid inflammation control. Use as short-term bridge therapy. Examples: prednisolone, methylprednisolone.

Conventional DMARDs

Slow disease progression. Anchor drugs: methotrexate, sulfasalazine, leflunomide.

Biologic DMARDs

Target immune pathways. Use for moderate to severe disease. Examples: TNF inhibitors, IL-6 inhibitors, abatacept, rituximab.

Targeted synthetic DMARDs

Oral agents with rapid onset. Examples: tofacitinib, baricitinib, upadacitinib.

First-line therapy

Methotrexate is the anchor drug. Start early after diagnosis to prevent irreversible joint damage. Prescribe folic acid to reduce toxicity.

Key adverse effects to watch

• Infections with biologics and JAK inhibitors
• Hepatotoxicity and cytopenias with methotrexate
• Osteoporosis and hyperglycemia with long-term steroids

Monitoring parameters

• CBC, liver enzymes, renal function before and during therapy
• ESR and CRP to track disease activity
• Screen for TB and hepatitis before starting biologics

Major drug interactions

• Methotrexate combined with NSAIDs or trimethoprim raises toxicity risk
• Live vaccines are contraindicated with biologics
• JAK inhibitors plus strong immunosuppressants raise infection risk

Clinical tips

• Treat early and escalate therapy quickly if control is inadequate
• Use steroids only for short-term bridging
• Vaccinate patients before initiating biologics
• Monitor labs at regular intervals and document disease activity
• Patient adherence determines long-term outcomes

Key takeaway

Rheumatoid arthritis requires early diagnosis and structured drug therapy. Methotrexate remains central. Biologics and JAK inhibitors improve outcomes in resistant disease. Regular monitoring prevents complications and preserves function.

Published by Dr. Sunil Paul. Series: Rx Insights.