Rheumatoid Arthritis Drug Guide

Rheumatoid arthritis (RA) is a progressive inflammatory disease that affects the joints. It gets worse over time unless the inflammation is stopped or slowed. Only in very rare cases does rheumatoid arthritis go into remission without treatment.

Arthritis medications play an essential role in controlling the progression and symptoms of rheumatoid arthritis. Starting treatment soon after diagnosis is most effective. And the best medical care combines rheumatoid arthritis medications and other approaches.

You may take rheumatoid arthritis medications alone, but they are often most effective in combination. These are the main types of RA medications:

  • Disease-modifying anti-rheumatic drugs (DMARDs)
  • Biologic response modifiers (a type of DMARD)
  • Glucocorticoids
  • Nonsteroidal anti-inflammatory medications (NSAIDs)
  • Analgesics (painkillers)

In the past, doctors took a conservative, stepwise approach toward treating rheumatoid arthritis. They started first with NSAIDs such as ibuprofen. Then, they progressed to more potent RA drugs for people who showed signs of joint damage.

Today, doctors know that an aggressive approach is often more effective; it will result in fewer symptoms, better function, less joint damage, and decreased disability. The goal, if possible, is to put the disease into remission.

Rheumatoid Arthritis Drugs: DMARDs

If you’ve been diagnosed with rheumatoid arthritis, your doctor may recommend that you begin treatment with one of several types of DMARDs within a few months of diagnosis. One of the most important drugs in the arsenal for treating rheumatoid arthritis, DMARDs can often slow or stop the progression of RA by interrupting the immune process that promotes inflammation. However, they may take up to six months to be fully effective.

DMARDs have greatly improved the quality of life for many people with rheumatoid arthritis. These RA drugs are often used along with NSAIDs or glucocorticoids; however, with this type of medication, you may not need other anti-inflammatories or analgesics.

Because DMARDs target the immune system, they also can weaken the immune system’s ability to fight infections. This means you must be watchful for early signs of infection. In some cases, you may also need regular blood tests to make sure the drug is not hurting blood cells or certain organs such as your liver, lungs, or kidneys.

Rheumatoid Arthritis Drugs: Biologic Response Modifiers

Biologic response modifiers are a type of DMARD. They target the part of the immune system response that leads to inflammation and joint damage. By doing this, they can improve your condition and help relieve symptoms.

These RA medications can’t cure rheumatoid arthritis. If the drugs are stopped, symptoms may return. But just as with other DMARDs, biologic response modifiers may slow the progression of the disease or help put it into remission. If your doctor prescribes one of these RA drugs, you will likely take it in combination with methotrexate. Biologic response modifiers are taken by injection and/or by IV and are expensive. Their long-term effects are unknown.

NOTE: Before taking biologics, it’s important to get appropriate vaccinations and to be tested for tuberculosis and hepatitis B and C.

Rheumatoid Arthritis Drugs: Steroids

They are strong anti-inflammatory drugs that can also block other immune responses. Several man-made steroids calls corticosteroids help relieve RA symptoms and may stop or slow joint damage. You receive these RA drugs by pill or as a shot.

Because of the risk of side effects, it is generally recommended that you use these RA drugs only for brief periods; for example, when your disease flares up or until DMARDs are fully effective. If your side effects are severe, don’t stop taking the drug suddenly. Talk first with your doctor about what to do.

Rheumatoid Arthritis Drugs: NSAIDs

NSAIDs work by blocking an enzyme that promotes inflammation. By reducing inflammation, NSAIDS help reduce swelling and pain. But they are not effective in reducing joint damage. These drugs alone are not effective in treating the disease. They should be taken in combination with other rheumatoid arthritis medications.

As with glucocorticoids, you should use them for brief periods — they can cause severe digestive tract problems. Which type, if any, your doctor prescribes may depend upon your medical history. If you have a history of liver, kidney, heart problems or stomach ulcers, it’s best to not take these drugs. Ask your doctor whether any new NSAIDS producing fewer side effects are available.

Rheumatoid Arthritis Drugs: Analgesics

Analgesics reduce pain but they do not reduce swelling or joint damage.

There are a variety of over-the-counter and prescription analgesics. Narcotics are the most powerful type of analgesic. Use these carefully and be sure to let your doctor know if you have any history of alcoholism or drug abuse.

Sources

  1. American College of Rheumatology: “Rheumatoid Arthritis."
  2. Amgen Prescribing Information, Amjevita.
  3. Arthur Kavanaugh, MD, rheumatologist; professor of medicine, University of California at San Diego.
  4. Arthritis Foundation: “Drug Guide."
  5. eMedicine Health: “Rheumatoid Arthritis."
  6. FDA: “Therapeutics for Rheumatoid Arthritis." “FDA approves Inflectra, a biosimilar to Remicade.” “Prescribing Information, Infliximab-dyyb (Inflectra)." “FDA approves Amjevita, a biosimilar to Humira.”
  7. Medscape: “FDA Approves Orencia."
  8. Simponi. 
  9. Singh, R. Current Opinion in Rheumatology; vol 17: pp 274-279.
  10. WebMD Medical News: “New Rheumatoid Arthritis Drugs Work Well." “Celebrex Linked to Heart Attacks."
  11. WebMD Medical Reference from Healthwise: “Rheumatoid Arthritis — Medications."
  12. WebMD Medical Reference provided in collaboration with Cleveland Clinic: “Arthritis Medicines Overview," “Steroids to Treat Arthritis," “Disease-Modifying Medications," “Biologics."
  13. MedlinePlus: “Methylprednisolone.”

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