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Answers tagged DMARD: Page 1 of 1
Q:

Robert from the United States asks: Is leflunomide a steroid?  Can leflunomide and prednisone be used together?

Prednisone is a steroid, while leflunomide (Arava) is a disease modifying anti-rheumatic drug (DMARD) used to treat rheumatoid arthritis.  Another term for DMARDs is a steroid sparing agent, meaning they aim to achieve the same goals as steroids, but ideally with less side effects.   Prednisone works much faster than leflunomide, days versus weeks.  Because of that, it is not unusual for a patient to be started on both: Prednisone to help control symptoms short term and then stopped once leflunomide has begun to take effect.  This same idea would apply for most DMARDs.

Q:

David from Lethbridge asks:  I am being switched from leflunomide to a biologic.  Should there be a period of time that I stop the leflunomide prior to starting the new medication?

Whether or not medications can be taken at the same time, close in time, or need a brief break in time, depends on the medications being considered.  For leflunomide, it is common to use it at the same time as many biologics.  If it is being stopped, there is typically no reason to wait to start the biologic.  They should not interfere with each other.  For rheumatoid arthritis, it is, in fact, very common to use a number of the disease modifying medications (DMARDs) together, and often in combination with a biologic.  For instance, to be on methotrexate, hydroxychloroquine, and sulfasalazine at the same time is a common regimen known as triple therapy.  It is also common to be on a regular DMARD while on a biologic.  It is not considered safe to be on two biologics at the same time.

Q:

Fanchi from Edmonton asks: I may have rheumatoid arthritis but have not been diagnosed yet.  What can I do, if my symptom continues, before I meet a rheumatologist?
If I have to use expensive biologic DMARD, is there any way to find some insurance plans that can cover most of the cost?

For patients with rheumatoid arthritis, the use of disease modifying medications is key to control symptoms AND more importantly, the underlying disease.  For a variety of reasons, it can take time for them to work, but there are other options to control symptoms, such as pain, while waiting.  While best to discuss with your own physician, anti-inflammatories (NSAIDs) are a good first choice for many patients, such as ibuprofen or naproxen.  Sometimes, cortisone injections into particularly painful joints, or even a short course of prednisone by mouth, could be used.  Physical therapy also has an important role to protect joints in this early phase of rheumatoid arthritis.

While expensive, rheumatologists in Alberta are usually able to work with patients to find a way to fund biologic medications.  It would be unusual to not provide needed treatment because of funding issues for most patients with rheumatic diseases in Alberta.

Q:

Elizabeth from Australia asks: I have rheumatoid arthritis and have been on traditional DMARDs.  My rheumatologist is now considering a biologic DMARD, but they are expensive.  In Alberta, how are biologic DMARDs paid for?  What is the wait time to a see a rheumatologist in Alberta?

Biologic DMARDs are very expensive, with most costing approximately $20,000 annually.  Alberta Health does not subsidize this cost directly, but currently, every Albertan is eligible to pay for medication insurance that would reduce out of pocket costs for biologics by about 90%.  For most patients in Alberta, rheumatologists and their team are able to work with patients to find a way to get the medications they need to ensure their health.

Wait times to see a rheumatologist vary in Alberta between Calgary and Edmonton, and even among rheumatologists.  However, most rheumatologists want to see patients with inflammatory arthritis within 3 months of a referral.

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