Combining medicines provides the best arthritis relief

People with rheumatoid arthritis (RA) are likely to get the best relief from joint pain and tenderness if they take a combination of medications, according to a new report. Unless it’s treated effectively, RA, an inflammatory disease that damages joint tissue, can progress and lead to serious complications, including cardiovascular disease and eye problems. Several classes of RA drugs are available, but it is not clear if any of these is clearly more effective than the others.

In the recent study, researchers reviewed previous reports that examined the effects of three classes of RA medications: traditional, synthetic disease-modifying antirheumatic drugs (DMARDs); the newer biologic DMARDs; and corticosteroids. Traditional DMARDs include hydroxychloroquine (Plaquenil), leflunomide (Arava), methotrexate, and sulfasalazine (Azulfidine); so-called biologic DMARDs include abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), etanercept (Enbrel), infliximab (Remicade), and rituximab (Rituxan); and corticosteroids include drugs such as prednisone.

The researchers concluded that no single drug works best against RA. Rather, combinations of the two kinds of DMARDs produced the best outcomes for patients. Methotrexate combined with any one of the biologic drugs was found to be especially effective, and it worked better than either methotrexate or a biologic DMARD alone. In addition, combining prednisone with a traditional DMARD works better than the DMARD alone. In people who had been treated with a single drug and had not gotten relief, switching to a combination of two different DMARDs often produced good results.

The report includes some cautions: The authors note that biologic DMARDs and methotrexate do increase the risk of serious infection and can have significant side effects. In addition, about 17 out of 1,000 people taking biologic DMARDs for at least three months develop a serious infection, and taking more than one biologic DMARD can increase this risk. More research is needed to determine the long-term effects of these medications, the authors say.