Meds

Hi, !

That's a really good question with a nuanced answer. While most medications used to stop/slow the immune response of RA do suppress or shortcut the immune system, some treatments used to treat the symptoms (but not the cause) do not.

That was kind of a confusing sentence, I know. So, steroids and pain medications used to help with RA are not immunosuppressants, but I bet you already know that. Traditional DMARDs are considered immunosuppressants -- https://rheumatoidarthritis.net/treatment/traditional-disease-modifying-anti-rheumatic-drugs. Biologic DMARDs (and biosimilars) technically don't 'suppress' the immune system, but they do impact it. I know that seems like kind of a slippery answer, but we're getting pretty technical here. So, here's some basic info on those biologic DMARDs -- https://rheumatoidarthritis.net/treatment/biologics. But. To just cut to the chase. Yes. Most traditional medications to treat RA specifically WILL impact your immune system, by design. Methotrexate is a pretty "heavy hitter", so you may talk to your doctor about less aggressive medications, if you would like.

It really comes down to what is best for YOU. These medications can slow the joint damage caused by untreated RA, but they do come with some pretty hefty potential side effects. You have to do what is best for you and your quality of life. I would definitely keep discussing it with your physician and I hope he/she would respect your decision, whatever it may be.

I hope this helps and that my reply didn't just muddy the waters!

Best, Erin, Team Member.

Hi . This is a great question. While the RA medications are immunosuppressants, they do not all act in the same way. Methotrexate is more of a blanket immunosuppressant. Biologic medications on the other hand focus on specific parts of the immune system. For example Enbrel and Humira are what are known as TNF inhibitors. This article from our editorial team on biologics lists which type of autoimmune inflammatory cytokine each drug inhibits: https://rheumatoidarthritis.net/treatment/biologics. The difference between blanket immunosuppressants and those that are targeted seems to be the reason that for certain vaccines, such as COVID, those on blanket immunosuppressants, such as methotrexate, are suggested to take a break from the medication (see here for example: https://www.arthritis.org/health-wellness/about-arthritis/related-conditions/other-diseases/pause-methotrexate-doubles-covid-vaccine-response). Your doctor should be able to provide additional information. Best, Richard (Team Member)

My rheumatologist started me on methotrexate when I was first diagnosed in 2021.
I have a strange system anyway (many drugs don’t affect me at all). Methotrexate has no effect on me. I thought it was some kind of sugar pill, but the insurance required I stay on that for x-amount of time before I could try anything else.
Finally, my Dr put me on Rinvoq— a fairly new treatment at the time. It worked well along with some others: ie.,hydroxychloroquine & leflunomide-low dose.
Then I started having lots of flares in 2024. My Dr changed me to Xeljanz.
I did not realize just how well Rinvoq worked for me until I tried Xeljanz. It was awful awful!! Finally I’m back on Rinvoq. I just had to find what worked “best.”
Prednisone is helpful but I refuse to take it because of side effects.
I also take pain meds which help but also bring about another set of side effects— one that even led to a burst appendix and abscess…

And the beat goes on…😊