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What medications are people taking that have diagnosed MS and RA? Neurologist is saying the combination of treatments is troublesome?

A MyMSTeam Member asked a question 💭

Diagnosed with RA in 2021. Have severe RA symptoms taking methotrexate and inflixamab infusions. Newly diagnosed with MS, neurologist says that finding an MS medication that will work with the RA medications is hard because of infection risk. Anybody have any insights?

March 29
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A MyMSTeam Member

Yes rituximab would be your solution - very similar to ocrevus (altho there are significant differences- I wrote a whole article about it for the mighty which you can see on my page because those differences were a concern for me personally) but used for RA. Many people with MS also use it. So there’s your solution- one treatment that hits both your issues at once. It is much cheaper than ocrevus as well.

March 30
A MyMSTeam Member

Rituximab is a treatment for RA and is used off-label for MS hope this helps

March 29
A MyMSTeam Member

I don’t have RA , so I am not sure. Do you see an MS specialist? What has neurologist suggested, they usually know what medications can be safely taken together. Maybe you can reach out to a specialty pharmacy and speak with a pharmacist? Good luck

March 29
A MyMSTeam Member

Thank you all I appreciate the information. So far all I have gotten from my doctors is stop your TNF blocker infusions and we will figure it out in a few months. While I am currently bedridden and going to be in a massive amount of pain without treatment for either disease so I am taking all this to the doctors.

March 31
MyMSTeam

What medications are people with both MS and RA taking, and why is the combination challenging?

Your neurologist is right to be cautious. When you're taking medications for both MS and RA, the main concern is that many of these treatments suppress your immune system, which significantly increases infection risk when Show Full Answer

What medications are people with both MS and RA taking, and why is the combination challenging?

Your neurologist is right to be cautious. When you're taking medications for both MS and RA, the main concern is that many of these treatments suppress your immune system, which significantly increases infection risk when combined.

A MyMSTeam member shared: "I was diagnosed with RRMS in 2008, then rheumatoid arthritis in 2013. I manage both diseases through exercise and diet in conjunction with DMDs."

The challenge with your current situation is that both methotrexate and infliximab (which you're taking for RA) already suppress your immune system. Adding certain MS disease-modifying therapies can further weaken immunity, making infections more likely. Here's what makes certain MS medications particularly risky when combined with RA treatments:

- Biologics like natalizumab (Tysabri) combined with your current RA medications can significantly raise infection risk
- Sphingosine 1-phosphate receptor modulators such as fingolimod (Gilenya) already reduce the immune system's ability to fight infections, and adding them to your RA regimen compounds this risk
- Steroids used during MS relapses can further increase infection risk when you're already on immune-suppressing RA medications

Your neurologist will need to carefully balance managing both conditions while minimizing infection risk. This typically involves close monitoring and potentially choosing MS therapies that have less immune suppression or work through different mechanisms than your RA medications.

Keep your healthcare team informed about all medications you're taking, and watch for any signs of infection while they work to find the right combination for you.

March 29

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