Combination therapy is a common treatment approach for many chronic conditions, including rheumatoid arthritis. Even though it's usually best to keep your medications to a minimum, it's not always possible, especially when multiple factors play a role.

Modern rheumatoid arthritis care focuses on early, aggressive treatment - and one that's gaining popularity is combination therapy with multiple disease-modifying antirheumatic drugs or DMARDs. However, treatment results in patients show that using just one DMARD is often not effective enough to slow the progress of rheumatoid arthritis.

Rheumatoid arthritis is a chronic condition that can severely damage joints, cause chronic pain, and limit mobility and function. Combination therapy with DMARDs directly modifies processes in your body that may cause the disease. However, each drug affects different chemicals, such as tumor necrosis factor alpha or interleukin-1, so it's often necessary to use more than one.

According to the Arthritis Foundation, methotrexate (Trexall® or Rheumatrex®) is the most common disease-modifying antirheumatic drug used in combination therapy for arthritis. It may be prescribed in conjunction with others medications such as etanercept (Enbrel®), leflunomide (Arava®), and hydroxychloroquine (Plaquenil®).

Unlike non-steroidal anti-inflammatory drugs and analgesics, the favorites for treating rheumatoid arthritis in the past, DMARDs used in combination therapy can slow the progress of the disease and joint damage. However, these drugs also carry serious side effects.

Risks of Combination Therapy for Rheumatoid Arthritis

Disease-modifying antirheumatic drugs such as methorexate can cause serious side effects, including:

  • nausea and vomiting
  • diarrhea
  • liver toxicity and functional problems
  • impaired blood cell production
  • rashes
  • mouth ulcers
  • high blood pressure
  • fatigue
  • birth defects
  • kidney problems
  • increased risk of cancer
  • hair loss

Methotrexate and some other DMARDs, such as Enbrel and Humira®, also increase your risk of infections such as pneumonia. If you are taking these drugs in combination therapy for rheumatoid arthritis, it's highly recommended that you get a pneumonia shot, or at the very least a flu shot.

Making the Decision to Try Combination Therapy for Arthritis

One of the first steps you'll need to take is to determine if the risks outweigh the benefits. When you're first diagnosed with rheumatoid arthritis, discuss it with your doctor. You'll need to consider a lot of information, and time is of the essence. Other things to consider:

• The costs. Find out how much the therapies cost and contact your health care provider to find out what they will cover. If you're not covered, check out public programs such as Medicaid or Medicare.

• The outcomes. Know what to expect from treatment. Ask your doctor how DMARDs will affect your rheumatoid arthritis symptoms, including inflammation, stiffness and pain. Also, get an idea of how long it will take to see results.

• Ways to reduce side effects. You may be able to limit some of the adverse reactions caused by combination therapy. For instance, you should abstain from alcohol when taking DMARDs, or take folic acid to counteract problems with blood cell formation or birth defects. Lowering the dose may also prevent hair loss, states the Arthritis Foundation. Discuss these precautions with your doctor.

Although you may find the list of side effects of combination therapy worrisome, the effects of rheumatoid arthritis are also quite severe. Weigh your options carefully and work closely with your rheumatologist to keep your disease under control so you can enjoy better health and mobility in the future.

Sources: Arthritis Foundation, Johns Hopkins Arthritis Center, American College of Rheumatology