About 1.5 million people in the U.S. suffer from rheumatoid arthritis, a painful autoimmune disorder that primarily affects smaller joints, like those in the feet and hands. While it can occur at any age, it most commonly begins between the ages of 30 and 60, and nearly three times as many women have RA as do men. RA is part of a class of conditions called rheumatic diseases, which encompasses more than 100 types of arthritis and immune disorders. Specifically, rheumatism covers any condition characterized by inflammation or pain in muscles, joints or fibrous tissues.
Rheumatoid arthritis symptoms are usually marked by periods of low intensity and suddenly increasing intensity, generally called flares. These flares can last for days or months at a time, but some people have continuous symptoms as well. Common symptoms include:
- Morning stiffness in joints lasting a few hours
- Tender or painful joints
- Swollen or warm joints (inflammation)
- Firm bumps under the skin on the arms, called rheumatoid nodules
- Weight loss
Because RA is a chronic disease, there is no cure available. However, there are medications that can reduce the frequency of flare-ups, limit pain and inflammation, and lessen the impact of RA on a patient’s life. In some cases, doctors also prescribe physical therapy to help patients protect joints, or surgery when pain becomes too great to function.
The first line of defense against rheumatoid arthritis is usually a form of the generic drug methotrexate, which comes in name brands Rheumatrex and Trexall. Doctors usually start with this drug because it is in a class of its own and as such is far cheaper than other RA drugs; it costs only about $240 per year. Methotrexate has been around for decades as an approved treatment for psoriasis and some cancers. If methotrexate has negative side effects, your doctor may discontinue it in favor of a biologic; if it is not strong enough, your doctor may add a biologic drug to the methotrexate regimen.
A biologic drug is a genetically engineered medication that copies the effects of your immune system. For autoimmune diseases like RA, biologic drugs target the specific abnormalities of your immune system to stop it from attacking your joints. Because these drugs are engineered from human tissues, not chemical formulations, they are very expensive and can be a financial burden. What’s more, most are only available as injections or IV infusions. The exception is Xeljanz, the first of several pill-form alternatives to biologics in development.
Choosing a biologic drug is complicated and requires the evaluation of cost, safety and dosing regimen, or how often the drug is taken. Biologic drugs for RA are very costly, and especially so for heavier people taking drugs like Orencia or Remicade, which are dosed based on the patient’s weight. Because biologics are so new, none is available as a generic. But once existing patents run out in a few years, pharmaceutical companies are likely to develop generics, which could lower costs.
All biologic drugs on the market are currently considered safe for use, but some have lower reported rates of side effects in clinical trials, and some have been shown to work better. Humira and Enbrel have shown the highest efficacy in clinical trials, with few injection-site reactions. Because Xeljanz is a pill (and not a true biologic), there is no risk of infection or skin reaction. The more often a drug is taken, the higher the chance for an adverse infusion- or injection-site reaction. Dosing regimens for biologic RA drugs are as follows.
|Biologic Drug name||Usual Dosing Regimen||Yearly cost (rounded)|
|Actemra®(Toclizumab)||Every 4 weeks as an IV infusion or shot, with dose dependent on weight.||$11,000-$23,000|
|Cimzia®(Certolizumab pegol)||Self-administered shot, 200 mg every 2 weeks or 400 mg every 4 weeks.||$35,000|
|Enbrel®(Etanercept)||Self-administered shot, 50 mg once per week or 25 mg twice weekly.||$33,000|
|Humira® (Adalimumab)||Self-administered shot, 40 mg every 1 or 2 weeks.||$32,000-$63,000|
|Kineret®(Anakinra)||Self-administered subcutaneous injection (shot), 100 mg daily.||$36,000|
|Orencia®(Abatacept)||IV infusion in a clinic setting every 4 weeks, or self-administered shot once weekly, with dosage dependent on weight.||$23,000-$32,000|
|Remicade®(Infliximab)||IV infusion in a clinic setting every 4 weeks, with dose dependent on weight.||$23,000-$46,000|
|Rituxan®(Rituximab)||Two 1000 mg IV infusions in a clinic setting separated by 15 days, repeating every 6-12 months depending on symptoms.||$15,000-$29,000|
|Simponi®(Golimumab)||One injection every four weeks of either 50 mg or 100 mg, dependent on weight and symptoms. Used in addition to methotrexate.||$17,000-$35,000|
|Xeljanz®(tofacitinib citrate)||One 5 mg pill taken twice daily||$30,000|
If you have rheumatoid arthritis, make sure you research your treatment options before making a decision. Talk with your rheumatologist about which treatment is right for you. Because these drugs are costly, you may qualify for financial assistance from the manufacturer, even if you have insurance.
Woman with pills image via Shutterstock