What Is the Safest Treatment for Rheumatoid Arthritis?

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如果你怀疑you may have rheumatoid arthritis (RA)—or your doctor has recently diagnosed you—then you’re probably already experiencing the classic symptoms of painful, achy, and swollen joints, especially first thing in the morning or after a long day sitting at work.

与其他类型的关节炎,可以布拉夫t on by too much activity, rheumatoid arthritis symptoms tend to happen when you’ve been at rest, not using your joints. Maybe you wake up in the morning and feel stiff. Or maybe you get out of the car after a long trip and find your body will barely move. The discomfort in your joints is the result of an overactive immune system that mistakenly attacks the tissue that lines your joints. The result is pain and inflammation and, over time, damage to the joints that can lead to deformity and disability. You may not know anyone else with the disease, but if you have rheumatoid arthritis, you’re in good company: RA is the second most common type of arthritis, affecting 1.3 million Americans.

这个good news about rheumatoid arthritis is that there are many different治疗方案“当有人患上类风湿性关节炎时，我告诉他们，我可以让他们感觉更好，并阻止他们疾病的进展，”纽约市纽约大学兰贡健康中心的风湿病学家、医学博士丽贝卡·布兰克（Rebecca Blank）说。问题是，哪些治疗效果最好，哪些最安全？从这些联合储蓄选项开始。

治疗类风湿性关节炎有哪些药物？

这个类风湿关节炎药物你最终的结果将取决于你的症状和疾病的严重程度。为了帮助减轻疼痛和炎症，你的风湿病学家（这是你为类风湿关节炎所见的专家类型）可能会建议非处方或处方非甾体抗炎药（比如布洛芬或萘普生）或短期皮质类固醇。但最终目标是阻止或减缓疾病的进展，防止潜在的软骨和骨损伤。为此，你的医生可能会从治疗疾病的抗风湿药物（DMARDs）开始。这些药物会减缓你过度活跃的免疫系统，所以它不会攻击你关节周围的组织。

医生具体选择哪种药物取决于你的病情严重程度。纽约州石溪市石溪医学院风湿病学系助理教授赛卡·沙米恩医学博士说：“如果有人的疾病活动性较低，我们可以提供羟氯喹，这是其中免疫抑制作用最低的一种。”。

对于中重度疾病，起点通常是甲氨蝶呤。如果这没有帮助，你的医生可能会转而使用生物药物。生物制剂是针对细胞因子的单克隆抗体，细胞因子参与导致炎症的免疫反应。它们包括肿瘤坏死因子抑制剂（TNF抑制剂）、B细胞抑制剂、T细胞抑制剂和不同类型的白细胞介素抑制剂。Sharmeen博士说：“当DMARDs还不够时，我们会加上一种生物疗法，或者叫做三联疗法，即一次口服三种药物。”。

副作用最小的类风湿性关节炎药物

First, let’s get this out of the way: All drugs come with side effects. Your physician will balance your quality of life with the severity of the disease when choosing the right med for you. The RA drug with the least side effects is hydroxychloroquine (Plaquenil). “We don’t consider it immunosuppressive, and it doesn’t cause elevated liver markers or kidney issues like some of the other drugs,” says Dr. Sharmeen. However, that doesn’t mean it’s without side effects at all. “We have patients monitored by an ophthalmologist for retinal toxicity, which can happen over 10 years,” she says.

Methotrexate, considered a first-line drug for moderate RA, is also well tolerated. But it can cause elevated liver enzymes. When choosing between the two, your doctor will consider your lifestyle. For example, if you drink alcohol, methotrexate may not be your best option.

甲氨蝶呤和来氟米特哪个更安全？

这个se two DMARDs have a very similar safety profile, says Dr. Sharmeen. Yet, methotrexate is considered a first-line drug, while leflunomide is a second-line medication. Why? “Methotrexate is tolerated better and works a little better for rheumatoid arthritis,” she says. Research has shown more improvement when methotrexate is the initial medication. A study published inRheumatology表明，甲氨蝶呤的改善在一年后比服用leflunomide为ra的那些改善更重要。

Are Biologics Safer Than Methotrexate?

Oral drugs such as methotrexate can cause non-serious immediate side effects such as nausea and GI issues. They can also cause hair loss. "With biologics, we don’t see those immediate side effects, but they have a potential for more serious side effects—even though we don’t see them often,” says Dr. Sharmeen. The most common生物制品副作用是注射部位的皮肤反应。最严重的副作用是感染的可能性，包括肺结核和乙型肝炎等疾病的重新激活、某些癌症的风险增加以及肝损伤。

和你的医生谈谈类风湿关节炎的治疗方法

服用药物时，你应该和风湿病专家讨论一些事情。首先，告诉你的医生你是否打算很快开始一个家庭（无论你是女性还是男性）。布兰克博士说：“有了这些药物，你想在试图怀孕或试图让你的伴侣怀孕之前停止服用大约三个月。”。

另一方面，DMARDS磺基碱和羟基氯喹对怀孕安全，因此如果您计划怀孕，您的医生可能会启动您的医生。理论上，您可以在某些TNF抑制剂生物药物上，直到您的第三个三个月，Sharmeen博士说。“但是唯一一个安全的是Cimzia，”她说。

You also want to talk about your lifestyle. For example, if you drink alcohol your doctor will avoid a drug that affects your liver enzymes. And tell your physician if you tend to get a lot of recurrent infections, upper respiratory infections, or are around young children who may pass along infections—your doctor may choose a less immunosuppressant drug if your situation makes you more vulnerable to infections. “These are all important things for your doctor to know to find the right for you,” says Dr. Sharmeen.

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克里斯塔·贝内特·德马约

克里斯塔·贝内特·德马约has well over a decade of editorial experience. The former magazine-editor-turned-freelance writer regularly covers skincare, health, beauty, and lifestyle topics. Her work has appeared in national publications and websites includingOprah,妇女健康,红皮书,形状,Dr. Oz The Good Life，bhg。com和预防。通用域名格式。她与丈夫和三个女儿住在纽约的亨廷顿。

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