Rheumatoid arthritis (RA) is a chronic inflammatory disorder that primarily affects the joints, leading to painful swelling and potential joint deformities.
The management of RA has evolved over the years, with a myriad of medications available to help control symptoms, prevent joint damage, and improve the patient's overall quality of life. A recent study published in "Orthopädie & Rheuma" sheds light on some crucial aspects of medication selection for RA.
Pain Management in RA
For individuals affected by rheumatoid arthritis, pain management is of paramount importance. According to PD Dr. Jan Leipe from the Universitätsklinikum Mannheim, pain remains a top priority for RA patients, even after a year of therapy. While pain is associated with inflammation, it can persist even when the therapy successfully addresses the inflammation. So, what analgesics are suitable for RA?
Acetylsalicylic acid, when used in analgesic doses, can enhance the effects and toxicity of Methotrexate (MTX), leading to cytopenias. However, such doses are rarely used in rheumatology. The risk of cytopenia with MTX and non-steroidal anti-rheumatic drugs is more dependent on kidney function. A relatively new finding is the interaction between MTX and Metamizol, which increases the risk of agranulocytosis. This risk increases with age.
Medication During Pregnancy
Prof. Dr. Klaus Krüger, a rheumatologist from Munich, highlighted that the risk associated with MTX varies depending on its administration. The risk is present a day before and after the MTX dose but is generally absent otherwise. Before pregnancy, MTX should be paused three months prior to conception. Hydroxychloroquine and Sulfasalazine are considered safe during pregnancy. While there's ample experience with Tumor Necrosis Factor (TNF)-α blockers during pregnancy, a transfer across the placenta occurs in the third trimester, potentially increasing the risk of neonatal infection. However, no such increased risk of infection has been observed in practice.
It's often recommended to get vaccinations before starting immunosuppressive therapy, as the success of the vaccination could be reduced otherwise. However, this doesn't always hold true. For instance, the humoral immune response to the Herpes-zoster vaccine under therapy with the Janus kinase inhibitor Upadacitinib is similar to that in the general population.
In conclusion, the selection of medications for RA is a complex process that requires a thorough understanding of the patient's condition, potential drug interactions, and other factors like pregnancy. This study provides valuable insights that can guide clinicians in making informed decisions for their patients.