Options for Aching Joints: RA Meds Go Head to Head

Nearly 1.3 million Americans endure the effects of rheumatoid arthritis (RA), leaving them with painful, swollen joints. This disease develops when the immune system mistakenly targets the linings of joints. The current front-line treatment to counteract this autoimmune attack is the medication methotrexate which suppresses inflammation by dampening the body’s immune response.

Methotrexate, in a class of medications called disease-modifying antirheumatic drugs (DMARDs), is not the only option for treatment, of course. Xeljanz® (tofacitinib) is another FDA-approved treatment for RA; it works in a different way than methotrexate, by inhibiting the enzyme janus kinase.

There have been numerous studies of Xeljanz alone or combined with methotrexate. The latest, reported in the New England Journal of Medicine, compares Xeljanz to methotrexate head to head in nearly 1,000 RA patients. After randomly being assigned to the methotrexate or the Xeljanz groups, patients were tracked for six months in terms of:

  • Joint damage,
  • Tender/swollen joints,
  • Disease improvement,
  • Pain level,
  • Degree of disability,
  • C-reactive protein level or erythrocyte sedimentation rate,
  • Patient’s global assessment of disease, and
  • Physician’s global assessment of disease.

So what was the outcome? Patients in the Xeljanz group showed greater improvements in signs and symptoms of RA, as well as less progression of joint damage, than the methotrexate group. However, side effect considerations do need to be kept in mind. Xeljanz (and methotrexate, as well) can lead to immune-related problems, such as an increased cancer risk and herpes zoster, which is why this medication carries an FDA black box warning.

Sidebar: The RA-Friendlier Life

For rheumatoid arthritis (RA), choosing the best medication for a patient isn’t the only choice to be made. Lifestyle choices also affect disease progression and symptom relief. Chief in this area is smoking.

  • Quitting smoking can ease RA symptoms.
  • Some symptom relief can also come from exercises to strengthen supporting muscles around the joints (avoid exercising a sore or inflamed joint, however).
  • Applications of hot or cold to the affected joint can provide pain relief.
  • Avoid foods high in fat, such as ice cream, cheese, and butter, to help reduce inflammation.
  • Choose foods high in omega-3 fatty acids, such as flaxseeds, walnuts, and salmon, to lessen inflammation.

Stephen C. Vogt, Pharm.D.
President and CEO
BioPlus Specialty Pharmacy



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Lee EB, Fleischmann R, Hall S, et al. Tofacitinib versus methotrexate in rheumatoid arthritis. N Engl J Med 2014;370:2377-86.

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