One of the most frequent questions newly diagnosed patients ask is: “Do I really need to take these (scary sounding) medications?”
Today I’ll be sharing some of the scientific evidence showing how effective rheumatoid arthritis medications are, as a response to the many “wellness influencers” and well meaning friends and family members who often pressure patients to “stay away from those toxic medications” or “just change your diet / lifestyle and you’ll avoid those scary medications.”
The “TLDR (too long didn’t read)” version is: the evidence is overwhelmingly in favor of medications for slowing down disease progression for people with RA *at the population level.*
How effective are rheumatoid arthritis medications?
When you take large groups of people with rheumatoid arthritis and assign some of them to a medication group and some to a placebo group, the medication group reliably (over multiple studies over the last 20+ years) has better outcomes in terms of joint damage, pain, and overall quality of life (for citations, see the research articles cited below).
Does this mean every *individual* gets relief with medications? Unfortunately, no. There is a small group, approximately 5-20% of patients with rheumatoid arthritis, who have what scientists and doctors call “difficult to treat RA.” This is RA that does *not* seem to respond as quickly or well to the modern Western medications that work so well for others.
Why is it dangerous to discourage people with RA from taking medications?
Fear mongering around medications is not in the best interest of most RA patients who will eventually need some level of medication therapy to prevent irreversible joint damage and achieve the best quality of life possible.
Scroll to bottom for peer reviewed journal article citations and and let me know what you think!
“Progression from symptom onset to significant disability is now no longer inevitable”
Citation #1: “Evolution of treatment for rheumatoid arthritis.” Katherine S. Upchurch, Jonathan Kay, Rheumatology, Volume 51, Issue suppl_6, December 2012, Pages vi28–vi36, https://doi.org/10.1093/rheumatology/kes278 https://academic.oup.com/rheumatology/article/51/suppl_6/vi28/1787530
Excerpt: “Current therapy for RA is such that progression from symptom onset to significant disability is now no longer inevitable, and RA patients can anticipate comfortable and productive lives on medical therapy” (in this context “medical therapy” means medications).
How effective is methotrexate for rheumatoid arthritis?
Jeffrey A. Sparks. Rheumatoid Arthritis. Ann Intern Med.2019;170:ITC1-ITC16. [Epub 1 January 2019]. doi:10.7326/AITC201901010
Excerpts from article:
- “Methotrexate is considered “backbone” of RA treatment because of its known efficacy and safety as initial monotherapy or combination treatment.”
- “About half of all patients treated with methotrexate have little or no radiographic progression, although 30% will require addional DMARDs (like biologics).” (Radiographic progression means visible joint damage on X-ray or other imaging techniques)
- “In most patients, RA is a chronic, progressive disease characterized by episodes of disease flares or long-term chronic inflammation. Only a few patients achieve long-term remission without the need for long-term medications.”
A treat-to-target approach is best for rheumatoid arthritis
Citation: Efficacy of biological disease-modifying antirheumatic drugs: a systematic literature review informing the 2016 update of the EULAR recommendations for the management of rheumatoid arthritis. Nam JL, Takase-Minegishi K, Ramiro S, et al, Annals of the Rheumatic Diseases 2017;76:1113-1136.
Retreived from: https://ard.bmj.com/content/76/6/1113?ijkey=874cefc0f9b09b2db43bb53e76c04eabadbe615c&keytype2=tf_ipsecsha
Excerpt from conclusion section of article:
“The most important findings in this update SLR were as follows: patients on MTX (methotrexate)monotherapy achieved sustained remission when following a treat-to-target strategy.23 Results from new strategy studies23 ,24 in this regard support those from previous RCTs1 ,3 and allow a firm conclusion: a treat-to-target approach, escalating csDMARD (conventional synthetic disease modifying anti rheumatic drug) therapy and adding a bDMARD (biological disease modifying anti rheumatic drug) in cases of non-response, is an effective approach.”
What about “difficult to treat” Rheumatoid Arthritis?
Citation #5: Watanabe R, Okano T, Gon T, Yoshida N, Fukumoto K, Yamada S and Hashimoto M (2022) Difficult-to-treat rheumatoid arthritis: Current concept and unsolved problems. Front. Med. 9:1049875. doi: 10.3389/fmed.2022.1049875
Excerpt from article: “”Patients whose disease activity cannot be controlled even with the use of two or more bDMARDs or tsDMARDs (b/tsDMARDs) with different mechanisms of action (MOA) are referred to as bearing “difficult-to-treat RA…Prevalence is estimated in the… 5-20% range.”
Have any follow up questions? Drop them in the comments!
