Medications for rheumatoid arthritis: What you need to know

What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is a long-term autoimmune disease that causes inflammation of the joints; this can lead to pain in the neck, shoulders, elbows, wrists, fingers, hips, knees, feet, and/or ankles. Other common symptoms include body stiffness and fatigue. RA usually occurs in joints on both sides of the body at the same time.

Even though the symptoms of rheumatoid arthritis may come and go in cycles called “flares,” RA can still cause permanent joint damage. It can also interfere with daily activities.

If you have RA, there are many medications that can control pain and slow joint damage. You and your health care provider will work together to choose the treatment that’s best for you.

How is rheumatoid arthritis treated?

Most experts recommend that you start taking medication as soon as possible, even if your RA symptoms are mild. The earlier that treatment is started, the better the chance of slowing the disease and preventing joint damage.

RA medications fall into three main groups:

    • Analgesics

 

    • Anti-inflammatories

 

    • Disease-modifying antirheumatic drugs (DMARDs)

 

Analgesics (pain relievers)

Analgesics are medications that can relieve the pain of rheumatoid arthritis, but they don’t reduce swelling or prevent joint damage. Analgesics include acetaminophen, low-dose aspirin, and low-dose nonsteroidal anti-inflammatory drugs (NSAIDs). You can usually buy these medications without a prescription. If they don’t ease your pain, your health care provider may try one of the other common drugs used to treat RA symptoms.

Narcotics, also known as opioids, are the strongest type of prescription analgesic. They’re good at relieving pain, but they can also have some serious side effects, like constipation and drowsiness.

Anti-inflammatory medications

Like analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce the pain and swelling of RA, but they don’t stop joint damage. Common side effects include indigestion, nausea, and vomiting. Some NSAIDs, such as ibuprofen and naproxen, may cause ulcers or bleeding in the stomach if they’re used often. Others, like celecoxib, can ease pain with less risk of causing ulcers or stomach bleeds.

Steroids, such as prednisone, can also help to treat pain and inflammation. Over the long term, though, steroid medications have many serious side effects like bruising, mood swings, weight gain, acne, and a higher risk of infection. Your provider will try to limit your use of steroids and keep the dose as low as possible.

You should know that these steroids aren’t the same as anabolic steroids, the banned substances that athletes sometimes use to build muscle.

DMARDs

The medications that work best to treat rheumatoid arthritis are called disease-modifying antirheumatic drugs (DMARDs). These prescription medications don’t just relieve pain; they can also stop joint damage. Experts feel that anyone with RA should consider taking a DMARD right away, even if symptoms are mild. The goal is to get the disease under control as soon as possible.

Some DMARDs come in pill form, and others are given by a shot or IV. It may take a while for these medications to work – anywhere from six weeks to a few months. Examples of DMARDs are methotrexate, sulfasalazine, leflunomide, infliximab, adaluminab, anakinra, and abatacept.

Different types of DMARDs have different risks. With some DMARDs, there’s a chance of birth defects, and liver damage. Many DMARDs can also make it harder to fight off infections.

Your health care provider will run some tests before you start taking these medications to make sure that your body is healthy enough to handle them. Tests may include blood work and a skin test for tuberculosis. You should also be up to date with your routine vaccinations.

Remember to meet with your health care provider regularly. Also, never change your medications, or start taking new ones, without talking to your provider first.

References

Agency for Healthcare Research and Quality (2008). (Search on “rheumatoid arthritis medicines”). http://www.effectivehealthcare.ahrq.gov/repFiles/RheumArthritisConsumerGuide_Singlepage.pdf

 

Johns Hopkins Medicine (2011). (Search on “Johns Hopkins rheumatoid arthritis”). http://www.hopkins-arthritis.org/arthritis-info/rheumatoid-arthritis/

Lorig, K., & Fries, J.F. (2006). The arthritis helpbook: A tested self-management

program for coping with arthritis and fibromyalgia.Sixth edition. Cambridge, MA: Da Capo Press.

Mayo Clinic (2011). (Search on “rheumatoid arthritis treatments & drugs”). http://www.mayoclinic.com/health/rheumatoid-arthritis/DS00020/DSECTION=treatments-and-drugs