Medication & Side Effects

Rheumatoid arthritis, or RA, is an autoimmune and inflammatory disease, which means that your immune system attacks healthy cells in your body by mistake, causing inflammation (painful swelling) in the affected parts of the body.

RA mainly attacks the joints, usually many joints at once. RA commonly affects joints in the hands, wrists, and knees, In a joint with RA, the lining of the joint becomes inflamed, causing damage to joint tissue. This tissue damage can cause long-lasting or chronic pain, unsteadiness (lack of balance), and deformity (misshapenness).

RA can also affect other tissues throughout the body and cause problems in organs such as the lungs, heart, and eyes.

So

RA = INFLAMMATION = PAIN  

LONG TERM  INFLAMMATION = DEFORMATIES 

So

CONTROL/REDUCE  INFLAMMATION = LESS PAIN & LESS DEFORMATIES!

NSAIDs Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Stronger NSAIDs are available by prescription. Side effects may include stomach irritation, heart problems and kidney damage.

Steroids. Corticosteroid medications, such as prednisone, reduce inflammation and pain and slow joint damage. Side effects may include thinning of bones, weight gain and diabetes. Doctors often prescribe a corticosteroid to relieve symptoms quickly, with the goal of gradually tapering off the medication.

Conventional  DMARDs.  These drugs can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage. Common DMARDs include methotrexate (Trexall, Otrexup, others), leflunomide (Arava), hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine). Side effects vary but may include liver damage and severe lung infections.

Biologic agents.  Alsoknown as biologic response modifiers, this newer class of DMARDs includes abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituximab (Rituxan), sarilumab (Kevzara) and tocilizumab (Actemra).

Biologic DMARDs are usually most effective when paired with a conventional DMARD, such as methotrexate. This type of drug also increases the risk of infections.

Targeted synthetic DMARDs.  Baricitinib (Olumiant), tofacitinib (Xeljanz) and upadacitinib (Rinvoq) may be used if conventional DMARDs and biologics haven't been effective. Higher doses of tofacitinib can increase the risk of blood clots in the lungs, serious heart-related events and cancer.

Medication overload among older adults — also known as polypharmacy — is a real and devastating public health issue. As a report by the nonprofit Lown Institute noted, “Over the past few decades, medication use in the U.S., especially for older people, has gone far beyond necessary polypharmacy to the point where millions are overloaded with too many prescriptions and are experiencing significant harm as a result.”

Those harms have a real-life impact: Every DAY! in America, 750 older adults are hospitalized due to side effects from one or more medications. And the Lown Institute predicts that in the next 10 years, 150,000 older adults will die prematurely due to medication overload.

As We Age, We Metabolize Less Effectively

There’s a reason over-medication disproportionately impacts older adults. Normal ageing leads to changes in some vital organ functions. A person’s lungs, kidneys and liver, for example, don’t work as efficiently with age. This means that an older person’s body metabolizes medication less effectively, putting them at greater risk for side effects.

The more medications you are taking, the higher the risk of those drugs interacting dangerously with each other. Multiple medications can cause confusion, lightheadedness and even internal bleeding — all dangerous and injurious conditions.

Hydroxychloroquine may cause serious side effects. Call your doctor at once if you have:

• a seizure;

• yellowing of your eyes;

• ringing in your ears, trouble hearing;

• unusual mood changes;

• severe muscle weakness, loss of coordination, underactive reflexes;

• any sudden changes in mood or behavior, or thoughts about suicide;

• low blood cell counts - fever, chills, tiredness, sore throat, mouth sores, easy bruising, unusual bleeding, pale skin, cold hands and feet, feeling light-headed or short of breath

• low blood sugar - headache, hunger, sweating, irritability, dizziness, fast heart rate, and feeling anxious or shaky; or

• a serious drug reaction that can affect many parts of your body - skin rash, fever, swollen glands, muscle aches, severe weakness, unusual bruising, or yellowing of your skin or eyes.

• Taking hydroxychloroquine long-term or at high doses may cause irreversible damage to the retina of your eye. Stop taking hydroxychloroquine and tell your doctor if you have:

• blurred vision, trouble focusing, trouble reading;

• distorted vision, blind spots;

• changes in your colour vision;

• hazy or cloudy vision;

• seeing light flashes or streaks, seeing halos around lights; or

• increased sensitivity to lig

Common side effects of hydroxychloroquine may include:

• headache;

• dizziness;

• nausea or vomiting;

• stomach pain;

• loss of appetite;

• weight loss;

• feeling nervous or irritable;

• skin rash or itching; or

• hair loss.
  
  

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

These are not all the possible side effects of sulfasalazine. For more information, ask your doctor or pharmacist.