What are the immunosuppressant therapies for RA?


Since the 1950s, medication-based therapies are approved for the management of the chronic disorder of rheumatoid arthritis. This autoimmune disorder has no known cure; however, management therapies as suggested by experts such as Rheumatologist in Lahore are used to control the symptoms and prevent worsening.

Read on to know more about the immunosuppressant therapies for rheumatoid arthritis:

Immunosuppressive therapy in Rheumatoid Arthritis 

The role if immunosuppressive drugs has been approved by the American Rheumatism Association after conducting many well-controlled trials. The mainstay of treatment includes drugs like: leflunomide, methotrexate, azathioprine, 6-mercaptopurine, chlorambucil and cyclophosphamide. These drugs come under the banner of DMARDs—disease modifying anti-rheumatic drugs.

Along with non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, DMARDs form the base of pharmacological therapy for rheumatoid arthritis.

Disease Modifying Anti-Rheumatic Drugs (DMARDs)

DMARDs were introduced to change the course of disease and improve the clinical outcome of RA patients. They are the only drugs in the treatment options available to do so. Earlier, DMARDs were started later in the course of disease. However, clinicians now prefer to start DMARDs as soon as the diagnosis of RA is confirmed.

DMARDs are available as liquids, injections, capsules and tablets. What will work best for the patient is decided by the healthcare provider. Usually a combination of drugs is prescribed to manage the symptoms while suppressing the immune system.

All immunosuppressant drugs are riddled with side effects. This is why the healthcare provider will choose the therapy most suitable for the needs of the patients. To monitor these side effects, regular blood tests are performed. The doctor then changes the dosage or the drug based on the lab results and the response to medication.

Side effects of DMARDs

Each drug presents with its own set of side-effects, yet the side effect common to all immunosuppressants is: the risk of infection. Because these drugs suppress the defense mechanism of the body, opportunistic microorganisms can infest and cause infection. This also means that the infections are harder to treat as the body’s own cells are not helping. Signs of infection include: high grade fever with chills, fatigue, pain on urination, GI upset, pain in the back or abdomen.


When DMARDs are not enough to treat RA, doctors resort to drugs called biologics. These are genetically engineered proteins that work by blocking specific mediators of pain and inflammation in the body. Intake of these drugs work quickly to combat pain and swelling of RA. There are many different biologics available, each targeting a different protein in the inflammatory cycle. Examples of biologics include: abatacept, infliximab, rituximab and tocilizumab.

Combination therapy

As mentioned before, the drug regimen of RA is mostly combination based. Combination allows patient to get better with less damage to the joints and less pain. Even though no medication can reverse the joint damage due to RA, combination therapy can limit the extent of this damage and prevent future problems.

Treatment during pregnancy

Pregnant RA patients are hard to treat as all the anti-rheumatic options are unsafe for the baby. All DMARDs should be stopped immediately on finding that the patient is pregnant. Even though the safety of prednisolone is not established, it remains the best option to manage the joint symptoms with the lowest possible dose. For the first two trimesters, NSAIDs may also be used to manage the pain, but they should be avoided in the last trimester.

There is no single treatment option for RA. Most patients need combination of drugs chosen by Rheumatologist in Karachi, based on the severity of disease and the response of the body.

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