Rheumatoid Arthritis
Medications
Medications are the main treatment for rheumatoid arthritis. The type of medications used depends on the severity of your disease, how fast it is progressing, and how it affects your daily life.
It is common for people with rheumatoid arthritis to have periods when the disease eases and then times when it gets worse. A long-range treatment plan that takes into account your lifestyle, medical history, and treatment options should be developed, followed, and regularly reviewed by all those involved in your health care—most importantly, you.6
If your symptoms ease and you are in remission, you and your doctor will decide whether you can take less medication or stop taking medication. If your symptoms get worse, you will have to start taking medication again.
Medications to treat rheumatoid arthritis are used to:
- Relieve or reduce pain.
- Improve daily function.
- Reduce joint inflammation. Signs of joint inflammation include swelling, tenderness, and limited range of motion.
- Prevent or delay significant joint damage and deformity.
- Prevent permanent disability.
- Improve quality of life.
Medications called disease-modifying antirheumatic drugs (DMARDs) that can slow or sometimes prevent joint destruction are now recommended early in the course of the disease. All people with rheumatoid arthritis are considered candidates for DMARD treatment.6 DMARDs can help prevent the significant joint damage that may occur in the early stages of rheumatoid arthritis. DMARDs are also called immunosuppressive drugs or slow-acting antirheumatic drugs (SAARDs).
Early treatment with DMARDs may significantly reduce disease severity.9 A separate study recommended that DMARD treatment be continued for a prolonged period of time to sustain the benefit of disease control.9
DMARDS can be divided into two general categories based on how they work: oral DMARDs and biological DMARDs. Oral DMARDS are taken by mouth. They interfere with the making or working of immune cells that cause joint inflammation. Biological DMARDS are given by injection (infusion). They act in several different ways to affect how immune cells work. Biological DMARDs decrease joint inflammation and damage.
Medications may be given together. This is called combination therapy. Oral medications are combined with each other or with biological DMARDs. But biological DMARDs are not used with each other because of a higher risk of infection.
Combination therapy may allow for lower doses of an individual drug to be used, which may reduce the risk of side effects that can occur with higher doses. Studies have shown that combination therapy may be an effective way to reduce symptoms of rheumatoid arthritis, control the disease, and prevent it from getting worse.15
Some medications for rheumatoid arthritis may cause birth defects. If you are pregnant or are trying to become pregnant, talk with your health professional about your medications.
Medication Choices
Medications to slow the progression of disease: Disease-modifying antirheumatic drugs (DMARDs) are usually started within 3 months of your diagnosis and are used to control the progression of rheumatoid arthritis and to try to prevent joint deterioration and disability. DMARDs are often given in combination with other DMARDs or with other medications, such as corticosteroids or non-steroidal anti-inflammatory drugs (NSAIDs).6
Commonly used oral DMARDs:
- Antimalarial medications such as hydroxychloroquine (Plaquenil) or chloroquine
- Leflunomide (Arava)
- Methotrexate
- Sulfasalazine
Less commonly used oral DMARDs:
- Azathioprine (Imuran)
- Cyclophosphamide such as Cytoxan or Procytox
- Cyclosporine such as Neoral
- Gold salts such as Ridaura
- Minocycline such as Minocin
- Penicillamine such as Cuprimine
Biological DMARDs:
- Abatacept (Orencia)
- Adalimumab (Humira)
- Anakinra (Kineret)
- Etanercept (Enbrel)
- Infliximab (Remicade)
- Rituximab (Rituxan)
Medications to relieve symptoms, such as pain, stiffness, and swelling, may also be used. These include:
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as ASA (Aspirin), ibuprofen, or naproxen. NSAIDs are used to control pain and may help reduce inflammation. They do not control the disease or stop it from getting worse. NSAIDs may be combined with disease-modifying antirheumatic drugs (DMARDs).
- Corticosteroids such as prednisone or Medrol. Corticosteroids are used to reduce disease activity and joint inflammation. However, using corticosteroids as the only therapy for an extended time is not considered the best treatment. Corticosteroids are often used to control symptoms and flares of joint inflammation until DMARDs reach their full effectiveness, which can take up to 6 months.
- Analgesics (pain relievers). These do not reduce inflammation but may assist with pain control. Commonly used prescription analgesics include:
- Acetaminophen with codeine (such as Tylenol With codeine).
- Acetaminophen with hydrocodone (such as Hycodan).
- Tramadol.
- Propoxyphene (such as Darvon).
- Non-prescription acetaminophen may be used to reduce pain.
What to Think About
Some DMARDs can take up to 6 months to work. In some people, a certain DMARD may not work at all, and a different DMARD will be used. Rapid improvement should not be expected. Medications for rheumatoid arthritis are usually managed by a doctor who specializes in inflammatory diseases of the joints (rheumatologist).
Many DMARDs have serious side effects. Regular blood and urine tests are usually needed when using a DMARD to monitor the drug's effects on blood-producing cells (bone marrow), the kidneys, and the liver.
Experts are studying many medications that might be used for rheumatoid arthritis. Examples include:
- Tacrolimus (Prograf), an inhibitor of a protein called calcineurin. In one 6-month trial, people who had rheumatoid arthritis that had not responded to DMARD treatment experienced a reduction in disease activity and symptoms.16
- Tocilizumab is another biological DMARD that slows inflammation by inhibiting cytokine function. The results of research trials suggest that tocilizumab may reduce disease activity in rheumatoid arthritis.17 Tocilizumab is not yet available in Canada.
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| Author: | Carrie Henley Robin Parks, MS | Last Updated: October 13, 2006 |
| Medical Review: | Kathleen Romito, MD - Family Medicine Tom Bailey, MD - Family Medicine Stanford M. Shoor, MD - Rheumatology | |
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