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When Does RA Medication Start Working? What To Expect

Posted on July 06, 2022
Medically reviewed by
Diane M. Horowitz, M.D.
Article written by
Scarlett Bergam, M.P.H.

If you’re living with rheumatoid arthritis (RA), your RA treatment regimen may involve many kinds of medications. However, weeks or months into beginning treatment, you may be frustrated to find you’re still experiencing RA symptoms. It’s important to know how long each kind of RA medication can take to begin working. This information can give you realistic expectations when beginning a new medicine.

Time Until Symptom Relief, by Drug Class

It’s important to understand how long it can take before you begin to feel the effects of a new medication. RA drugs — including conventional disease-modifying antirheumatic drugs (DMARDs), janus kinase (JAK) inhibitors, biologic agents, corticosteroids, and nonsteroidal anti-inflammatory drugs (NSAIDs) — all work differently in the body. It can take days, weeks, or months before you begin feeling symptom relief, depending on the type of medication.

Conventional DMARDs: One to Three Months

Conventional DMARDs are common first-line treatments for RA. These medications block inflammation to help stop disease progression. Conventional DMARDs include:

These drugs slowly treat the root cause of your disease, hopefully leading to whole-body symptom relief over time. However, conventional DMARDs can cause serious — yet common — side effects. These include:

  • Gastrointestinal problems
  • Hair loss
  • Fatigue
  • Nerve damage
  • Liver problems
  • Increased risk of infection

You may be able to reduce these side effects by taking DMARDs with other drugs or supplements, such as folic acid. You should also have regular blood tests to check your liver function and blood count while taking conventional DMARDs.

These drugs are not designed to work immediately. You can expect DMARDs to start taking effect after one to three months, depending on which treatment you’re taking. Doctors often prescribe faster-acting, short-term drugs like corticosteroids and NSAIDs with DMARDs. These drugs can help to relieve pain and inflammation before DMARDs begin to work.

Some people with RA find the time it takes for DMARDs to work to be hard to handle. Their side effects can be another challenge. One myRAteam member described their experience with methotrexate: “Started methotrexate and not tolerating it. I’m so new to all of this. I wonder if my rheumatologist will lower the dose or have me keep trying; hoping it’ll improve in time.”

Talk with your doctor about how you’re handling treatment and how your symptoms change over time. They can work with you to find a medication or dosage that works best for you.

JAK Inhibitors: Three to Six Months

JAK inhibitors are another type of DMARD. They target specific pathways inside of immune cells — specifically, the proteins that trigger the immune system. JAK inhibitors reduce pain, inflammation, and swelling, and they can significantly slow the progression of joint damage over time. JAK inhibitors are taken as tablets once or twice a day. They include:

JAK inhibitors take approximately three to six months to reach their full effectiveness, but some people may see an improvement in symptoms after two weeks.

Biologic Drugs: Two to Six Weeks

Biologic drugs target specific molecules in the immune system that promote joint damage and inflammation. They may be administered as infusions or injections once every few weeks. Doctors typically prescribe them with conventional DMARDs to boost their effectiveness.

The major concern for people taking biologics is infection risk. People taking biologics should be up to date on their vaccines, and they should take precautions to avoid infections when possible.

Biologics include tumor necrosis factor inhibitors like:

Other biologic medications that target specific immune system cells include tocilizumab (Actemra), abatacept (Orencia), and rituximab (Rituxan).

Biologic drugs do not take effect immediately. One myRAteam member asked, “How long does a dose of Actemra take to take effect?” A fellow member replied, “I took Actemra for a while, and it took several weeks to start working.” Another said, “It took six months for me.”

Typically, biologics take from two to six weeks to begin working. They reach their maximum effectiveness in around 12 weeks.

Corticosteroids: Less Than One Week

Corticosteroids such as methylprednisolone (Medrol) and prednisone reduce inflammation and help regulate the immune system. Corticosteroids take effect much more quickly than DMARDs and biologics. They are often prescribed temporarily with DMARDs to treat joint pain and swelling before disease-modifying treatments take full effect.

Oral corticosteroids such as prednisone generally take one to four days before they begin to decrease inflammation and pain. Some people feel the effects after just a few hours. Doctors generally say to take oral corticosteroids early in the morning. Some doctors believe that taking them late at night will prevent RA morning stiffness.

Injectable corticosteroids can be administered directly into an inflamed joint or muscle. Short-acting steroids dissolve quickly in your body. They may take effect within 24 hours, and their effects last for about one week. Other injections may need up to a week to take effect and relieve inflammation and pain for up to two months.

Long-term steroid use is associated with weight gain, osteoporosis, increased blood sugar, and increased blood pressure. Steroids should only be used for short-term relief, such as during severe RA flares.

NSAIDs: Less Than One Hour

NSAIDs include over-the-counter and prescription pain relievers. Common NSAIDs for RA include naproxen (Aleve) and ibuprofen (Advil). Compared to DMARDs and steroids, NSAIDs have fewer side effects. They are also the fastest-acting drug for RA pain and inflammation. NSAIDs can be crucial in managing RA symptoms before other medications take full effect. However, they do not slow disease progression, and they are not recommended for long-term RA treatment.

NSAIDs typically take less than an hour to begin taking effect. Long-acting and delayed-release NSAIDs can take up to a few hours to reach their full effects. If you need immediate relief, some health care professionals recommend taking NSAIDs on an empty stomach. Taking a nighttime dose of long-acting or delayed-release NSAIDs may prevent RA morning stiffness.

Be sure to talk with your doctor about all medications you take, including over-the-counter NSAIDs. Do not start taking medications or supplements — even those available without a prescription — without talking with your doctor.

Stay in Touch With Your Rheumatologist

Sometimes, knowing that RA symptom relief is a few weeks away can make your symptoms and treatment side effects a bit more bearable. If you have any questions or concerns about your specific treatment plan, make sure to speak to your rheumatologist.

Talk With Others Who Understand

On myRAteam, the social network for people with rheumatoid arthritis and their loved ones, more than 193,000 members come together to ask questions, give advice, and share their stories with others who understand life with RA.

How long did it take for your RA drugs to start working? How did you handle your treatment side effects and RA symptoms while waiting for treatment to begin working? Share your experience and advice in the comments below, or start a conversation by posting on your Activities page.

All updates must be accompanied by text or a picture.
Diane M. Horowitz, M.D. is an internal medicine and rheumatology specialist. Review provided by VeriMed Healthcare Network. Learn more about her here.
Scarlett Bergam, M.P.H. is a medical student at George Washington University and a former Fulbright research scholar in Durban, South Africa. Learn more about her here.

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