Expert Q&A: RA Medication Side Effects Worse Than the Disease?

Question: After reading the pharmacy sheets listing side effects of the medications I take for rheumatoid arthritis (RA), I can't help but wonder if the "cure" is worse than the disease. Is it possible I'd be better off skipping the medications and taking my chances with the RA?

Answer: For those with arthritis, side effects of medication are an understandable worry. But I would hate to see fear cause you to give up medications completely. The dangers of untreated RA, psoriatic arthritis, lupus or other inflammatory diseases far outweigh the risks of the drugs used to treat it in most cases. Medications ease pain, prevent joint destruction and improve the lives of countless people with arthritis and related conditions. In some cases, medications can literally save lives.

The pharmacy sheets are provided as a service to make you aware of side effects that can occur with a certain medication. Keep in mind that the key word here is "can." You shouldn't assume that the listed side effects will necessarily occur in you. Even if you do experience one or more side effect, you may be able to reverse or halt them by stopping or changing medications. In many cases, no action is needed; the side effects resolve on their own.

Sometimes we have to risk experiencing a side effect to gain a medication's benefits. The key is weighing risks against potential gain. Your doctor can help you weigh those risks and choose the drugs that provide the most help and do the least possible harm.

There are also several things you can do to reduce your risk of drug side effects. Here are a few:

• Other medications. Let your doctor know about any other medications you are taking – even over-the-counter ones – because some can add to the side effects of others. For example, taking aspirin along with a prescription nonsteroidal anti-inflammatory drug (NSAID) can increase your risk of stomach problems.
• Supplements. Nutritional supplements can affect the way a drug – such as taking folic acid along with methotrexate. Vitamin supplements can reduce the risk of certain side effects. In other cases, supplements can interfere with the action of a medication or even enhance its potential side effects.
• Foods. Find out if there are certain foods you should eat or avoid while taking a medication. Most drugs, including NSAIDs, should be taken with food to reduce the risk of stomach upset. For others, such as minocycline, taking with food can decrease the drug's absorption.
• Alcohol. Forgo alcohol – it can add to the side effects of most drugs, from analgesics to antidepressants. If you can't or don't want to give up alcohol altogether, set a limit of two drinks (including beer) per week.
• Dosage. Ask your doctor to prescribe the lowest beneficial dose of a drug and never take more than the prescribed amount. Many side effects are related to dosage.
• Timing. Take the drug at the time designated by your doctor. Timing, in some cases, can influence a drug's side effects. For example, taking the osteoporosis drug alendronate when you get up in the morning, rather than before lying down at night, can cut the risk of esophageal ulcers.
• Consistency. Never stop taking any medication without consulting your doctor. A drug can't help you if you don't take it, but abruptly stopping a drug can hurt you. Drugs such as prednisone, for example, must be tapered slowly to avoid serious adverse effects.
• Communicate. Let your doctor know if you suspect a side effect. He can determine whether the side effect requires treatment, discontinuation or dosage reduction.

Leonard H. Calabrese, DO
Department of Rheumatologic and Immunologic Disease
Cleveland Clinic
Cleveland, Ohio