Leflunomide for Rheumatoid Arthritis: How It Works, Benefits & Side Effects

Introduction to Leflunomide for RA 0:00

If you have been told your rheumatoid arthritis medication isn't working, or if you could not tolerate it, this video is for you. Today we are talking about leflonamide, what it does, how it works and who it helps. Let's break it down in simple plain language. Hello all of you rheuma troughs warriors, This is Dr. Anand Subedi, your Rheumataid Arthritis goes at the room, Doc. Before I go further, don't forget to like and subscribe and also accept our gift, the free copy of the book and the recipe that you can find in the description below.

Let's start with the story of one of our patients. She is a 52 year old lady who came to me with rheumatoid arthritis. she used to love gardening, spending hours planting tomatoes, but her hands started betraying her. Her knuckles swelled, her fingers stiffened every morning and sometimes for over an hour she was not able to function. She came to us and we started her on methotrexate, the most common RA medication.

Patient Story: Methotrexate Intolerance 0:58

But the nausea was so severe that she could not tolerate. The fatigue was crossing so she can barely handle her day to day task. After months of trying, she looked at me and said, Dr. Shabedi, I don't think I can keep doing this. So we tried our best. We look for other tools in our toolbox and we found a medication called leflenomide, also called Areva. Let's first start understanding what actually happened in rheumatoid arthritis. Think of your immune system like a security team. Normally, it protects you, fighting off infection and keeping you healthy.

But in Rheumataid Arthritis, that security goes raw. It starts attacking hacking your own joints the lining the cartilage and even the bone underneath causing the damage this causes swelling pain stiffness and over time permanent joint damage that's why RA is not just the joint pain it's a joint destruction The goal of treatment is not just to make you feel better today. It is to stop that damage before it becomes permanent. Here is where leptinamide comes in.

How Rheumatoid Arthritis Damages Joints 2:16

Those raw immune cells, they need fuel to keep attacking. Specifically, the need building blocks to copy their DNA. Without those building block, They cannot keep multiplying. Leptinomide cuts off those buildings blocks. Think of like this. Those raw cells are a factory running 24x7. Leflenomide shut down a key supply chain to that factory. And here is what is clever about this. Normal cells in your body have a backup supply route. They are much less affected by leflinomid. But those overactive immune cells are greedy.

They need both routes to keep up with their rapid growth. Block the main route and those cells hit the hardest. Now the next question come up, how well does leflonamide work? In the last clinical studies, up to 50 to 55 percent of the patients saw significant improvement in their joint symptoms. That is compared to only 26 to 29 percent on people who are not on any medications, almost double the response rate. And that tells us this medication is effective to help control rheumatoarthritis.

How Leflunomide Works 3:25

Those numbers are very similar to methotrexate and sulfasalazine, the other main rheuma arthritis medications. But here's the bonus. leflenomide tend to kick in faster, it works faster than methotrexate. Many patients notice improvement within the first month of starting leflenomid. And perhaps the most important finding, lefenomides does not just reduce the pain, It actually slows down joint destruction on x-rays. That's the real goal, protecting your joints for 10 to 20 years from now so that it doesn't cause long term joint damage.

So the question come up, when do we use leflenomide? When do rheumatologists choose leflenomid over methotrexate? So these are two situations where we use leflenomide over methotrexate. And the number one situation is when you are not able to tolerate metho trexite, like our patient. Leflonomid works through a completely different pathway.

Effectiveness and Faster Symptom Relief 4:34

So the same side effects don't usually apply like methotrexate. And the situation number two, when metotrexit alone is not doing enough. Leflenomide can be added on top of metho trexite. Studies show the combination provide additional benefit because the two drugs work through two different pathways. Now, this is the most important question most of you are very scared of. What are the side-effects of leflonamide? Like any medication? leflenomide has side effects to know about. The most common ones, diarrhea, nausea, hair thinning and skin rashes and sometimes elevation of liver enzymes on your blood test.

But here's the good news. Most of these are manageable. Many improve if the dose is lowered from 20 milligram down to 10 milligram a day. the key message is don't just stop the medication on their own. talk to your doctor first adjust the dose so that you can tolerate the lower dose and also control your rheumatoid arthritis symptoms as you just heard about those side effects but here are some strategies that will help you minimize and monitor those effects and there are three important safety points

When Leflunomide Is Used 5:46

The first one, your doctor will check your liver and blood test. They usually do every 4 to 8 weeks in the first 6 months and every 8 to 12 weeks after you have been on long term medication. And the second one is very critical. Leptonamide is not safe during pregnancy. It can cause serious harm to the developing baby. If you are or might become pregnant, let your doctor know immediately. The third thing is, this drug stays in your body for a very long time. few weeks to months. If it needs to be cleared quickly, a special washout procedure is required using a specific medication called cholestaramine.

Side Effects and Safety Monitoring 6:34

But the bottom line is, leptinamide is well studied and effective, but it requires monitoring just like any other RA medications. So you might be wondering what happened to our patient. After starting leflenomide, the first few weeks were quiet. She wasn't sure anything was changing, but around week 6, she noticed something. Her morning stiffness was shorter, her hands didn't ache as much by the afternoon. By 3 months, She was back to her garden. gardening, what she really loved. This patient's story is not unusual, leptinamide has been helping patients with rheumatoid arthritis for two decades.

That's why if you are struggling managing your rheuma arthritis, ask your rheumatologist whether this could be a good choice for you. Now all of you rheuamatoids who are here, let me bring it all together. We talk about three important things about lethamamide. Number one, it works. It works differently than methotrexate, but it worse in significant amount of patients who have rheumatoid arthritis. it also slows down joint destruction. 2. Get your regular blood test, as recommended by your rheumatologist.

Patient Improvement and Closing Summary 7:50

3. Talk with your Rheumathologist, if your current treatment is not working, ask if leflenomide might be the right option for you. If you or someone you love has RA and is struggling, there are options lefina might might be the one that gives you your life back and fight against rheumatoid arthritis if this video helped you share it with someone who needs to hear this information and this might change your RA journey I'll see you in the next video bye bye