Understanding the Side Effects of Treatment for Rheumatoid Arthritis

Treatment for rheumatoid arthritis begins with and is usually dependent on medication. Many of these medications can sometimes cause serious side effects. When thinking about side effects of treatment, there are four important things to remember:

1. If untreated, rheumatoid arthritis leads to pain, dysfunction, and disability; if properly treated, the disease can be controlled, and functional status can be prolonged and often maintained.
2. The risk of side effects from treatment is many times less than the risk of deformity and disability if the disease is not treated.
3. Almost all side effects can be detected early and disappear when treatment is stopped.
4. The chances of serious side effects are low, and permanent damage from treatment is rare.

All of the medications used to treat rheumatoid arthritis have some side effects, and some of the medications have potentially severe side effects. These range from nausea and a mildly increased risk of infection to anemia and liver damage.

It would be best if health professionals knew which people are most likely to develop severe joint destruction and deformity from their rheumatoid arthritis and could recommend the most aggressive treatment only for these people. However, no such accurate projections of the course of the disease exist. At the same time, many of the current medications, when used early in the course of the disease, can significantly decrease the total damage done to the joints. Since rheumatoid arthritis is a progressive disease with joint deformities that cannot be reversed once they occur, most doctors have come to the conclusion that it is best to recommend early, aggressive treatment with careful follow-up to catch any treatment-related toxicity immediately rather than waiting for permanent damage to happen.

Lack of durability of rheumatoid arthritis treatments
For reasons that are not totally understood, many treatments for rheumatoid arthritis lose their effectiveness over time, and a sizable percentage of people being treated for rheumatoid arthritis will not be on the same treatment 5 years into their disease. Why this loss of effectiveness occurs is unclear, but it may be related to the immune system becoming desensitized by a given course of treatment. Fortunately, the development of additional medications that can fight rheumatoid arthritis provides further options for treating the disease if initial drugs lose their effectiveness.

The risk of not taking medical therapy
While there are risks associated with medical therapy for rheumatoid arthritis, it is worth remembering the risk of not taking the medication. Rheumatoid arthritis is a progressive disease that causes destruction and deformity of the joints. Once this damage occurs, it cannot be reversed. Medication must be taken early in the course of the disease, before significant damage has occurred, to prevent progression of the illness.

Making the decision to take the risk of side effects can be difficult. To minimize risks to yourself, it is important to make sure that you are in close contact with your health professional while starting medication to deal with and treat any potential toxicities of the medication early and to adapt your therapy to medications that you can tolerate and will take.