From healthcentral.com
You can’t believe everything you hear about therapies for this autoimmune condition. We asked experts to spell it out
When rheumatoid arthritis (RA) isn’t well-managed, it can cause painful joint swelling and stiffness, fatigue, and other health issues. Fortunately, there’s a wide variety of excellent treatment options for the autoimmune condition that can help curb inflammation and keep your symptoms at bay. In fact, the RA treatment landscape is so vast (and quickly changing) that it can sometimes feel like a lot to navigate. Especially given all the myths and misinformation floating around out there.
The misconceptions you hear about RA treatment can be confusing half-truths at best—and downright scary falsehoods at worst. And when you’re trying to approach living with RA from the most-informed, empowered place possible? Bad information about treatment is the last thing you need. So we asked rheumatologists to help us separate fact from fiction and debunk some of the most common RA treatment myths.
Myth #1: You Don’t Need Treatment Until Your Symptoms Get Bad
Some people think they only really need to start RA treatment when the pain becomes unmanageable and try to get by on over-the-counter painkillers in the meantime. But delaying treatment isn’t only painful; it can result in permanent damage to your body. “The sooner you start therapy, the more potential you have to prevent joint damage,” says Lesley Davila, M.D., an associate professor of internal medicine in the division of rheumatic diseases at UT Southwestern Medical Centre in Dallas, TX. Putting off treatment also increases the risk of complications. For example, uncontrolled chronic inflammation from RA can raise your risk of heart disease, says Gina Ferrero, M.D., an assistant professor of medicine in the division of arthritis and rheumatic diseases at the Oregon Health & Science University School of Medicine in Portland, OR. But research shows that biologics, for example, decrease the risk of cardiovascular events in people with RA.
So treating RA early and aggressively means symptom relief in the short term, and a healthier body in the long term.
Myth #2: Methotrexate Is the Same as Chemotherapy for Cancer
It’s true that methotrexate, a disease modifying antirheumatic drug (DMARD) that tamps down inflammation, is used as a chemotherapy agent in some kinds of cancer. But that’s hardly the full picture. Methotrexate as a cancer drug is used in much higher doses, Dr. Davila explains. Meanwhile, in smaller doses, it works by reducing symptoms and delaying the progression of RA.
In RA, the typical dose ranges from 10 mg to 25 mg per week, while the doses used for chemotherapy can be up to hundreds of times larger, according to the Arthritis Foundation. So the immune system suppression and side effects are extremely mild by comparison. “We have huge [amounts] of data that, as long as it’s monitored correctly, it’s very safe over long periods of time in rheumatoid arthritis,” Dr. Davila says.
The drug starts working pretty quickly (within six to eight weeks) to ease RA symptoms, it’s easy to take (with a weekly pill or injection), it’s safe and well-tolerated by most people, and it’s relatively inexpensive, according to the Johns Hopkins Arthritis Center.
But there’s a persistent myth that methotrexate is chemotherapy, which scares people away because of the side effects people on chemo tend to have during cancer treatment. “I have people that are very reluctant to consider methotrexate, even though it’s kind of our gold standard and has been around for a very long time,” says Dr. Davila.
Myth #3: Supplements Are Effective Replacements for Prescription Drugs
Dr. Davila gets a lot of questions about natural remedies for RA. Amid the sea of false claims, there is some decent data suggesting certain supplements may provide a modest benefit for some—but they are not a replacement for drug therapies in most cases. “One that we have a little bit of data on is curcumin/turmeric,” Dr. Davila says. Studies show that curcumin, an anti-inflammatory compound found in turmeric, can help reduce symptoms like joint pain and swelling in people with RA. Some research also suggests that omega-3 fatty acids could provide a modest benefit.
But there’s no evidence that supplements can do the job of prescription drugs. “These medications are essential for controlling RA,” says Dr. Ferrero. And if you have more aggressive RA, relying on supplements alone puts you at risk for more joint damage in the long term, Dr. Davila explains. If you’re wondering whether a certain supplement could benefit you, talk to your doctor. And think of it as a potential add-on, not a treatment in itself.
Myth #4: RA Drug Side Effects Will Ruin Your Life
“All medications can have side effects,” Dr. Ferrero says. “But most patients tolerate RA medications well.” Side effects are often mild. They can go away on their own or often be solved with an adjustment to your dosage or how you take the medication, Dr. Davila says. For instance, some people experience nausea when they start on oral methotrexate. Switching from pills to injections can lessen the effect, Dr. Davila says. So can moving from a morning to evening dose, so that you can sleep through the nausea. Starting at a very low dosage and ramping it up slowly might prevent that issue altogether.
If your side effects are more severe or persistent, your doctor can try you on something else your body agrees with better, Dr. Davila says. So be honest with them about what you’re experiencing.
Myth #5: A Special Diet Can Cure RA
“Anything you do in terms of living your best lifestyle can be helpful,” Dr. Davila says. But again, there’s no replacement for powerful RA meds in preventing disease progression. And while the American College of Rheumatology (ACR) recommends that people with RA eat a Mediterranean-style diet, it’s not the specific diet itself, but the anti-inflammatory foods (like fruits and vegetables) that are included in it that present the greatest health benefits since anything that helps lower the baseline level of inflammation in your body is a bonus with RA. The ACR also recommends minimizing inflammatory foods (like refined carbs and saturated fats) and advises steering clear of other diets, like a vegan or keto diet.
That said, even the most nutritious diet isn’t a substitute for medication. “While a healthy diet and lifestyle are important for managing RA, they are not a cure,” Dr. Ferrero says. “Medications remain essential for effectively controlling RA.” We may learn more about the role of diet as research on the connection between your gut and your immune system grows, Dr. Ferrero adds. But for now, an approach that combines medication and healthy living is best.
Myth #6: RA Medications Cause Cancer
Research does show that some RA drugs may increase the risk of cancer, Dr. Davila says. In one review of 22 studies published in Frontiers in Immunology (pooling data on 371,311 people with RA taking DMARDs), researchers found that people taking conventional synthetic DMARDs had a 15% higher risk of cancer overall. But you have to weigh a slightly increased risk of cancer against the considerable risks of not taking medication, Dr. Davila points out (like joint damage or heart problems from untreated RA).
If you’re at higher risk for cancer (due to family history, for instance), your doctor will factor that into which treatment options they recommend. (The Frontiers in Immunology study found that biologics, for example, did not cause an increased risk of cancer.)
Myth #7: When You Feel Better, You Can Stop Treatment
Once you’re feeling good again, it can be tempting to think you might not need your medication anymore. “I see that a lot,” Dr. Davila says. Studies on people in remission from RA have found that within one year of stopping their treatment, at least 50% will relapse. So some people can stay in remission without drugs for at least a year, Dr. Davila says. “But there are definitely people who feel it immediately.”
If you do experience a flare after going off your treatment, there’s a chance that your medication won’t work as well when you get back on—running the risk of joint damage while you and your doctor work to get you into remission again. So while it’s reasonable to consider stopping medication in some cases, “for the vast majority of people, they probably should be on at least some degree of therapy,” Dr. Davila says.
Myth #8: If Your First Treatment Doesn’t Work, Nothing Will
If your current treatment isn’t working very well, there’s a good chance another one works better for you. “We have just a ton of options right now, which is fabulous,” Dr. Davila says. (Plus, more are in development.)
But finding the best medication for you can involve some trial and error. “At this moment, we really can’t predict what your right drug is going to be,” Dr. Davila says. It’s very individual—so a drug that doesn’t do much for one person can be a fantastic match for another, Dr. Davila says. And some people do best with a multi-pronged approach, she adds—like using more than one drug or adding on physical therapy.
So if you’re unhappy with your current treatment, be open with your doctor. And if you’ve heard anything about RA treatment that concerns you—or that you’re not sure is true—always bring your concerns to your provider. “The underlying message is, have a good relationship with your rheumatologist and have a conversation back and forth,” Dr. Davila says. You’ll navigate your RA treatment choices together to find what works best for you.
https://www.healthcentral.com/condition/rheumatoid-arthritis/myths-and-facts-about-ra-treatment
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