Rheumatoid Arthritis Medication Side Effects Checklist

From NSAIDs and methotrexate to biologics and JAK inhibitors, rheumatoid arthritis (RA) patients have more treatment options now than ever before. These drugs can reduce pain and stiffness, improve mobility, and prevent serious disability, but any medication has also potential side effects and it’s smart to understand these fully.

Read more here about how a medication’s side effects are determined and get answers to patients’ biggest concerns about medication side effects.

It’s normal to feel overwhelmed by the laundry list of side effects announced at the end of a drug commercial, but you should know that which, if any, side effects could impact you is highly individualized.

Talking to your doctor about a medication’s potential risks and benefits — and how those fit in to your treatment goals and preferences — is part of shared decision-making, which is an important part of the doctor-patient relationship in rheumatology. You need to talk to your doctor about your health history, lifestyle, other medications you take, and other diseases you have in order to better understand which side effects are more likely to be an issue for you

Here are key questions to ask your health care provider or pharmacist to better understand RA drug side effects.

1. How might this medication help me?

The reason you need medication for rheumatoid arthritis is because you have a chronic, progressive disease. While you have to be aware of possible side effects of a drug, you also need to weigh them against the medication’s important benefits. Leaving your RA untreated or undertreated has serious risks. The danger of not treating your RA is much more significant than the odds of having a serious side effect from a medication.

Be sure you understand what the drug is designed to do and how likely it is (or isn’t) that it will have a beneficial impact on your health.

2. Does this drug interact with any other medication or supplement I take?

Your doctor should have already factored in your other medications before making a recommendation, but that’s not always the case — especially if you see multiple providers and take medication for more than one condition. Make sure your prescriber knows about everything you take, including over-the-counter (OTC) medications and vitamins and supplements.

3. What are the most common side effects of this drug?

There are many classes of RA medication and several drugs within each class. Each can have unique side effects compared with those in other classes or even within the same class, so it’s important to get specifics.

4. Is this drug associated with any serious side effects or ones that might require immediate medical attention?

Many rheumatoid arthritis drugs have black box warnings, which is the strictest type of warning the Food and Drug Administration (FDA) can require a manufacturer to put on a drug label, according to Barbara Young, PharmD, editor of consumer medication information at the American Society of Health-System Pharmacists.

Although severe side effects are unlikely to occur — if they happened too frequently the drug would be pulled from the market — it’s important to know what they are and which warning signs should prompt you to get help. For instance, if a drug might increase the risk of a pulmonary embolism, you should know to call 911 if you suddenly become short of breath, develop chest pain, or are coughing up blood.

5. How likely is it that I will experience any of these side effects? Is my personal risk higher — or lower — than that of other RA patients?

In general, there’s less than a 10 percent chance that you’ll experience any side effect of any FDA-approved medication and less than a 5 percent chance that you’ll experience a severe side effect (the kind that would require you to be hospitalized), says Kathryn Dao, MD, associate director of clinical rheumatology at Baylor Research Institute in Dallas, Texas. But if you have another condition (such as diabetes or high blood pressure), take several drugs at once, or are frail or elderly, your risk of side effects might be greater.

6. Can I do anything to reduce the chance of experiencing a side effect?

Taking a drug exactly as prescribed can help, but there may be additional steps you can take. Some side effects of methotrexate, for instance, can be mitigated or prevented by taking a folic acid supplement, says Dr. Dao. Ask your doctor about specific advice for all the medications you take.

7. If I’m not comfortable with the possible side effects of this drug, what are my options?

Your provider might really trust a certain drug or feel compelled to prescribe it because of official guidelines, but ultimately the choice is yours. “Doctors should be focusing on shared decision-making,” says Kevin Winthrop, MD, a professor of infectious diseases and public health at Oregon Health & Science University in Portland.

8. How long has this drug been on the market?

New drugs can be game changers, but until a medication has been on the market for at least a few years, the full side effect profile is evolving, says Dr. Young. Sometimes post-marketing studies —research that is done on a drug after it is FDA-approved — can reveal new information about the risks and prevalence of side effects. Patient reports of adverse events can shed new light on side effect risks once a larger group of people has been taking a drug for a few years.

Older drugs aren’t necessarily safer, says Dr. Young, but you can expect fewer surprises from them.

9. If I start this drug and experience side effects, how quickly can I change course?

You can usually stop a medication at any time, says Dr. Dao, but don’t stop taking a medication without first discussing it with your doctor. There are important caveats depending on the specific drug. Corticosteroid medications, such as prednisone, should not be stopped suddenly. They need to be tapered off slowly to avoid adrenal insufficiency. The biologic drug rituximab (Rituxan) — which is given as a two-series infusion every six months or based on your doctor’s evaluation — has a long half-life. Once you start rituximab, the drug will stay in your system for six to 12 months.

10. What should I do if I experience a side effect?

Your doctor might advise waiting a few days or even a few weeks to see if a milder problem like nausea or insomnia goes away, depending on the drug. Severe symptoms always warrant a call to your provider’s office, calling 911, or seeking emergency medical care.

When in doubt, call your doctor. “I tell patients to call me the moment they notice something,” says Dr. Winthrop. Your provider can help you figure out if the issue is likely to improve, requires medical attention, or if it’s actually not a side effect at all. “What you perceive as a side effect might be totally random, or it might be part of the disease itself,” says Dr. Dao.

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This article is part of a Patient’s Guide to Understanding RA Drug Side Effects and was made possible by a grant from Sanofi Genzyme.