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Top new treatments for Rheumatoid Arthritis

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Rheumatoid arthritis (RA) is a chronic condition that already affects around 1.5 million Americans, and about 100,000 new cases are diagnosed each year. It is one of the more than 80 conditions known as autoimmune diseases, and ranks near the top for worldwide incidence, with more than 25 million people affected. The term “rheumatoid arthritis” comes from Greek, meaning watery and inflamed joints. For an as yet unknown reason, women are about two to three times more likely than men to suffer from autoimmune diseases, and this is also the case for Rheumatoid Arthritis. The onset of symptoms is primarily during middle age but sometimes it can start as early as late puberty. In most cases, people with rheumatoid arthritis do suffer a reduction in life expectancy which can be influenced by the presence of other health problems (primarily heart disease, diabetes, alcohol abuse, and high cholesterol, blood pressure or obesity). The reason for this is largely unknown, but the presence of chronic inflammation could be a contributing factor. There are currently no cures and the primary aim of medications being prescribed now is to reduce the pain and swelling and to slow down the progress. 

What is known about the causes and effects of Rheumatoid Arthritis

RA is a disease in which the immune system attacks healthy cells by the body. Autoimmune diseases occur when the natural defense system can’t distinguish between the body’s own (and healthy) cells and foreign or diseased cells. In such a case, the body mistakenly attacks and kills normal cells. The result in rheumatoid arthritis is inflammation (swelling) of the tissues.  Rheumatoid Arthritis primarily affects joints. Most commonly, the knees, wrists and hands on both sides of the body are involved. It shows up as warm, swollen, and painful joints. In these joints the lining becomes inflamed, along with thickening of the joint capsule and change to the underlying bone and cartilage. This causes chronic pain, and misshapenness. Rheumatoid Arthritis can also affect other organs such as lungs, heart, and eyes. Rheumatoid Arthritis is usually diagnosed on the basis of a person’s symptoms and the external signs. It may be necessary to use X-rays and laboratory testing to exclude other diseases with similar symptoms, like psoriatic arthritis, systemic lupus erythematosus, and fibromyalgia.

Treatment of Rheumatoid Arthritis

Although no cures are currently available, there has been progress in several areas to bring relief and to delay the progress of the disease. The use of new biological therapies have been shown to both extend the lifespan of people with rheumatoid arthritis and reduce the symptoms. Traditional treatments focussed primarily on controlling pain, but the goals of the newer treatments are to slow down the progression of the disease, decrease inflammation, and improve the person’s overall experience. For pain relief,  steroids  and NSAIDs are frequently used.

New treatments for Rheumatoid Arthritis

In the table below, we are listing some of the most frequently prescribed rheumatoid arthritis medications, with price comparisons against standard US (non-coupon) supplies. In all cases, the drugs are sourced from the same manufacturers as you would be getting them from a US drug store.  
IsraelPharm price including delivery Avg. price / List price
Methotrex (DMARD) 2.5mg 50 Tablets – $21.61 $30 / $62
Arava (DMARD) 20mg, 30 Tablets – $75.00 10mg, 30 Tablets – $70.00 $124 / $190 $125 / $205
Plaquenil (DMARD) 100 Tablets – $55.00 $98 / $200
Enbrel (biologic) 50 mg 4 Injection pack – $2,301 25 mg 4 Injection pack – $1,162 $6430 / $10990 $3282 / $3874
Remicade (biologic) 100 mg Vial – $350.00 $1140 / $2280
Xeljanz (JAK) 11 mg 28 Tablets – $699.00  5 mg 56 Tablets – $699.00 $2552 / $2655 $4755 / $6250
Olumiant (JAK) 4 mg 14 Tablets – $285.00 $2283 / $4226
Disease-modifying antirheumatic drugs (DMARDs), biological DMARDs and JAK inhibitors are significant new developments in the treatment of rheumatoid arthritis. The main differences between them are:
  • DMARDs target the entire immune system
  • Biologics target specific steps in the inflammatory process and may be used when the condition is not responding to other treatments
  • JAK inhibitors block inflammatory actions from even starting.
Alternative to drug therapy, surgery to repair, replace, or fuse joints may help in certain situations. Doctors typically prescribe a combination of drugs, physical therapy, and lifestyle changes to help manage rheumatoid arthritis.  Generally, the more recent drugs for rheumatoid arthritis are expensive, but with the  help of IsraelPharm, you can save as much as 70% of the cost thanks to the caps that are placed on drug prices in Israel.
Plaquenil is a disease-modifying anti-rheumatic drug (DMARDs).
Disease-modifying antirheumatic drugs (DMARDs) help prevent joint damage and are normally part of the initial treatment of rheumatoid arthritis. It may take several months before the full benefits of a DMARD treatment. Your healthcare provider might choose  between several of the available versions of DMARDs before the right one is found. Common DMARDs include Methotrex (methotrexate), Arava (leflunomide), and Plaquenil (hydroxychloroquine). Biologic treatments are a newer form of treatment that are designed to prevent immune system attacks on joints. They require self-administered subcutaneous  injection and are usually prescribed in combination with a DMARD when that course of action has not been effective on its own. Common biologic treatments include Enbrel (etanercept) and Remicade (infliximab). Janus kinase inhibitors are a new type of DMARD that can be prescribed for patients who either cannot tolerate the side effects of DMARDs or who did not see sufficient  improvement from DMARDs. Common JAK inhibitors include Xeljanz (tofacitinib) and Olumiant (baricitinib).

Drugs taken to help reduce inflammation and pain

Doctors may prescribe taking medications to help manage pain, either temporarily during a flare-up, or regularly. These may be over-the-counter medications like nonsteroidal anti-inflammatory drugs (NSAIDs)  like Advil and Nurofen (ibuprofen) or Naprosyn (naproxen sodium), or  stronger drugs that include COX-2 inhibitors, like celecoxib (Celebrex) to reduce inflammation and pain which generally have fewer side effects and are safer for daily use than NSAIDs. When neither of these are working, there may be short-term use of injectable or oral steroids like , but the risks of more serious side effects may rule these out.
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