Most RA patients get to experience a wide variety of medications. Ask any long term patient and they can reel off a long list of medications tried and failed only to move onto the next experiment. Many RA bloggers include a diary of medications – past and present. This is because there is no cure for rheumatoid arthritis and current treatments are designed to either modify the biochemical processes causing the destructive symptoms or to provide relief of the symptoms. Disease modifiers (DMARDs) include chemicals like methotrexate, plaquenil, sulfasalazine, and Arava (leflunomide). They can also include biologicals like Enbrel, Humira, Remicade, Orencia among others. Symptom relievers may include prednisone and NSAIDS.
My experience is much like other RAers as I’ve been through a wide variety of medications (check out the My Meds page). In addition to 6 months of Orencia infusions now increased to 1000mg, Arava was added about 6 weeks ago. Combination therapies are the standard and research bears out that patients do better when a disease modifying chemical is added to a biological. This is the reason my rheumatologist recently added Arava. I couldn’t tolerate methotrexate, the most common DMARD. While I know that many do well with it, I never felt worse in my life when on methotrexate. The problem is that the DMARDs are strong chemicals which bring a whole host of side effects. It seems that many RA patients take additional medications just to combat the side effects. For example, folic acid and stomach acid blockers are common amongst methotrexate takers.
Arava, common name leflunomide, is newer than methotrexate and the safety profile is still emerging. While generally well tolerated, there are cases of numerous side effects ranging from mild to life threatening. I’ve been on Arava for almost 6 weeks starting with a 10mg daily dose. At that dose, side effects were pretty much non-existent after the first day but so was its impact on RA. This week the dose was increased to 20mg daily. My rheumatologist noted that my blood tests were doing well and wanted to increase the dose in an effort to more effectively impact RA symptoms. The day the dose increased, side effects became much more noticeable and include numerous gastrointestinal issues (I’ll spare the details). But at the same time, I began to notice RA symptoms beginning to diminish. It was with some hesitancy that I took the Arava pills this morning. After taking my other pills, the Arava sat next to a glass of apple juice for a while while contemplating what it was doing to me. Yes, I liked its impact on RA. No, I did not like the side effects. The pills were finally downed with trepidation wondering what side effect experiences would come. As the day progressed, I noticed that the side effects were much less than previous days. Perhaps my body was getting used to it. Time will tell. In the meantime, I’ll take the benefits of Arava and continue to monitor the side effects.