On medication choices for RA

[Guest guest]

Rheumatoid arthritis is a potentially devastating systemic disease. Not

everyone with RA has or will have the same severity of disease.

Unfortunately, though there are some markers for aggressive RA, it's not

possible to accurately predict the future of each RA patient.

Just a few years ago, rheumatologists routinely treated their patients with

early RA with NSAIDs and corticosteroids and, if necessary, used DMARDs

later in the disease course.

Today, we know that early and aggressive treatment is critical. Letting the

inflammation spiral out of control and permanent damage occur is not the

right approach. There is evidence that there may be a window of opportunity

in the first stages of the disease where the likelihood of quieting the

rheumatoid arthritis or even achieving remission is much greater than it

will be down the road.

Early and aggressive treatment means beginning one or more DMARDs upon

diagnosis (with any luck, an early and accurate one). The choice of DMARD or

which combination of them will depend on several things, most notably: the

severity of one's RA (or predicted severity), effectiveness of the DMARD,

toxicity of the DMARD, and cost of the DMARD.

Antibiotics have side effects, all DMARDs have side effects. Not everyone

will experience side effects, regardless of what they take.

So far, it has not been proven that any antibiotic has the disease-modifying

power of either methotrexate or the anti-TNF biologics.

According to the American College of Rheumatology:

" Minocycline is prescribed for patients with symptoms of mild rheumatoid

arthritis. It is sometimes combined with other medications to treat patients

with persistent symptoms of this form of arthritis. "

http://www.rheumatology.org/public/factsheets/minocycline.asp

" Mild rheumatoid arthritis " is the key phrase.

Minocycline, and, possibly, doxycycline, may be very good choices for some

people, but, currently, they are not recommended as monotherapy for those

with aggressive RA.

Many people with RA are successfully treated with a combination of DMARDs

from the start and, once the disease seems to be under control, the

medications are slowly scaled back and some discontinued. This strategy is

called " step-down therapy. "

Here are some excellent articles related to this discussion:

Hospital for Special Surgery

October 14, 2004

Paget, MD, FACP, FACR

" An In-Depth Topic Review of Rheumatoid Arthritis " :

http://www.hss.edu/Professionals/Conditions/Rheumatoid-Arthritis/Rheumatoid-Arth\

ritis---For-Physicians

Hospital for Special Surgery

Paget, MD, FACP, FACR

" How Medication Decisions are Made in RA Treatment " :

http://www.hss.edu/Conditions/Rheumatoid-Arthritis/How-Decisions-Are-Made-In-Ra-\

Treatment

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org