Arthritis and Rheumatism

Possible Rheumatoid Arthritis Treatments

08/25/2008 06:52AM

Question:

I have tried a lot of treatments for my RA. I am about to start Orencia. I am also taking Methotrexate, Prednisone, and NSAID. I have already tried Plaquenil, Enbrel, Humira (I had an allergic reaction to it). My doctor won`t put me on Remicade due to the allergic reation to Humira. If Orencia don`t work then what is next? Are there any treatments that I could mention to my doctor? My RA is severe and active.

Answer:

You have mentioned several agents in the class known as biologics that are used to treat Rheumatoid Arthritis (RA). The current FDA-approved biologics are etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), anakinra, (Kineret), abatacept (Orencia), and rituximab (Rituxan). As you can see, you have not tried all of the biologics. Other oral, disease-modifying antirheumatic drugs include leflunomide (Arava) and sulfasalazine (Azulfidine) to name just two.

Certain combinations of the above agents may be more efficacious while other combinations only add extra risk of side effects. It is one of the reasons that seeing a Rheumatologist is useful in helping you to make a decision regarding your care. There are multiple medications that are investigational and/or are being considered by the FDA for approval for use in RA. They may be available to you through a clinical trial.

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Response by:

Raymond Hong, MD, MBA, FACR
Assistant Professor
Division of Rheumatology
University Hospitals
School of Medicine
Case Western Reserve University