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            1. Finding Strength: Life With RA
              Rheumatoid Arthritis

              The Consumer’s Guide to RA and JAK Inhibitors

              Everything you need to know about the newest class of FDA-approved RA meds.

              I f you’re unhappy with your rheumatoid arthritis (RA) treatment plan, you may be wondering what’s next for you. The good news? Since the 1980s, advances in RA treatment options have continued to improve the ability to control RA. The newest class of RA drugs, called janus kinase inhibitors, or JAK inhibitors, are no exception.

              JAK inhibitors are the newest to the scene but have proven benefit in terms of reducing pain, improving function, and preventing long-term joint damage,

              JAK inhibitors were first approved by the U.S. Food and Drug Administration (FDA) in 2012. “JAK inhibitors are the newest to the scene but have proven benefit in terms of reducing pain, improving function, and preventing long-term joint damage,” says Brett Smith, DO, a rheumatologist at Blount Memorial Physicians Group in Alcoa, Tennessee, and East Tennessee Children’s Hospital in Knoxville. But are they right for you?

              Before you ask your doctor about JAK inhibitors, do your homework! It’s important to be an active participant in your care, and a big part of that is educating yourself and working with your doctor to make decisions about your treatment options. And we’re here to help.


              How JAK Inhibitors Work for RA

              As RA treatments have become more and more advanced through the years, the newest drugs provide a very targeted approach.
              The Evolution of Rheumatoid Arthritis Treatment

              RA is a type of autoimmune disease. While a healthy immune system protects the body by attacking foreign invaders like bacteria and viruses, with RA, the immune system mistakenly attacks the joints. Part of that immune response is to cause inflammation, which over time causes joint tissues to swell and thicken. Left untreated, RA can lead to permanent joint damage and deformity.

              JAK inhibitors are a new type of disease-modifying anti-rheumatic drug, or DMARD — meaning, aside from helping to alleviate RA symptoms, they also modify the course of the disease to prevent long-term joint damage. But they work much differently than traditional DMARDs like methotrexate, which suppress the entire immune system to reduce inflammation. JAK inhibitors target a very specific pathway that is critical to how RA develops and progresses. When that pathway is blocked, immune cells aren’t able to signal their attack on the joints, inflammation doesn’t develop, and (if successful) you don’t experience the symptoms and damage caused by RA.

              Before JAK inhibitors were first introduced in 2012, the most targeted type of RA medication was a class of drugs called biologics, which were deemed to be a very effective RA treatment. However, JAK inhibitors work in an even more targeted way, and research is proving that they’re just as — if not more — effective than certain types of biologics.

              7 Essential Facts About JAK Inhibitors for RA

              Even though JAK inhibitors have been around since 2012, for some, these medications still feel fairly new. Learning more about JAK inhibitors and what they bring to the table can help you feel more comfortable with them as an option for RA treatment. Here’s what you should know.

              Is It Time to Try a JAK Inhibitor to Treat Your RA?

              I f you’ve tried a variety of other RA meds and haven’t been able to successfully control your condition, you may be a good candidate for a JAK inhibitor. RA treatment tends to start with methotrexate or one of the other traditional DMARDs as first-line treatment, explains Bauer. Then your doctor may put you on a biologic before moving to JAK inhibitors.

              “Although TNF inhibitors have been the standard after failure of DMARDs, JAK inhibitors may be the new standard of care,” explains Smith, “but that is not clearly defined at this time.”

              The American College of Rheumatology (ACR) last updated their treatment guidelines in 2015 — before two of the three JAK inhibitors (baricitinib and upadacitinib) were approved by the FDA for treating RA. Though whether or not the ACR will change their recommendations in favor of JAK inhibitors in the future is to be determined.

              That said, the exact treatment plan your doctor prescribes can vary based on a lot of factors — including your disease severity, which medications you’ve tried already, your personal preferences, and your insurance coverage.

              Whether or not you’re a good candidate for trying a JAK inhibitor is a very individualized decision and will also include your medical history and other factors that affect your health risks.

              “JAK inhibitors are another option for many patients,” adds Smith, “but it really is a discussion between the patient and their physician on the most appropriate option.”

              Our Experts Answer Common Questions About JAK Inhibitors for RA

              Three rheumatologists weigh in on the top questions their patients ask about treating RA with JAK inhibitors.

              Next Steps: Making RA Treatment Decisions



              You’ve learned a lot about JAK inhibitors. So what’s next?

              Take some time to absorb all of this info and decide if JAK inhibitors are something you might want to consider.



              Before your next appointment, think about how you feel about your current treatment plan and how well it’s controlling your RA.

              1. Are you satisfied with your current treatment?
              2. Has it improved your RA symptoms as well as you had hoped?
              3. Are you downplaying your RA symptoms — or its impact on your quality of life — to your doctor?
              4. How frequently do you have to cancel plans or adjust activities because of RA?
              5. Are you following your treatment plan exactly as prescribed?
              6. Have you tried other options to see if they help you manage RA?

              Doctor Discussion


              If after your self-reflection you feel it’s time to discuss a potential?treatment change?with your doctor, bring this list of questions to your next appointment.

              1. Do you think it’s possible for me to gain better control of my RA?
              2. Which medication(s) are you prescribing for me, and why?
              3. Am I a good candidate for JAK inhibitors?
              4. What types of results can I expect?
              5. How often should we monitor the progress of my treatment?