Rheumatoid Arthritis Medications

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Although there is currently no cure for rheumatoid arthritis, there are various medications available that will improve the condition.  Rheumatoid arthritis medications can in general be grouped into the several categories described below.  Doctors will usually design proper medical treatment to both suppress the symptoms of pain and inflammation at the joints, and slow down the destruction of the cells in the joints.  This can be achieved by using a combination of the following drugs depending on the particular situation.

Below are some of the more popular medications that are used to treat arthritis, along with comments on their effectiveness and a list of side effects if any.  Some of these rheumatoid arthritis medications can be bought online (click here for a website that stocks many types of rheumatoid arthritis medications and ships worldwide).  However, please note that you should consult your doctor before starting any medical treatments.  Also, please read our site disclaimer before reading any further.

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

NSAIDs is a class of drugs that act to relieve pain and reduce inflammation.  They only treat the symptoms but does not prevent further joint damage.  NSAIDs work by preventing the body from producing prostaglandins, a substance which is responsible for causing pain and inflammation.

Example of NSAIDs are ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn), diclofenac (Cataflam, Voltaren), ketoprofen (Orudis), piroxicam (Feldene), etodolac (Lodine), indomethacin, oxaprozin (Daypro), nabumetone (Relafen), and meloxicam (Mobic), and Celecoxib (Celebrex).

Many doctors recommend NSAIDs as soon as rheumatoid arthritis is diagnosed in a patient.  However, if taken for long periods of time or in high dosages, NSAIDs can lead to serious side effects such as gastric ulcers, stomach bleeding, heart problems, and/or liver and kidney damage.

Corticosteroids

Another kind of drugs that are used to treat rheumatoid arthritis are corticosteroids, which act to reduce inflammation by suppressing the immune system.  Examples of corticosteroids include betamethasone (Celestone Soluspan), cortisone (Cortone), dexamethasone (Decadron), methylprednisolone (SoluMedrol, DepoMedrol), prednisolone (Delta-Cortef), prednisone (Deltasone, Orasone), and triamcinolone (Aristocort).

Although effective in their ability to treat RA, corticosteroids has serious side effects if used for long periods of time, such as glaucoma, easy bruising, thinning bones, cataracts, diabetes and weight gain.  Because of the potential of serious side effects, corticosteroids are normally only used as short-term treatment to bring sudden flare-ups of this disease under control.  Fortunately, a single corticosteroid injection may inhibit inflammation of a particular joint for a long time.

Disease Modifying Anti-Rheumatic Drugs (DMARDs)

DMARDs is a type of drugs that work by suppressing the immune system’s attack on the joints, thereby slowing down the progression of joint damage.  This type of arthritis medication is often used in combination with other medications to more effectively treat rheumatoid arthritis.  Since this joint damage is permanent and starts occurring in the early stages of the disease, many doctors recommend DMARD treatment immediately after RA is diagnosed.  People with RA are typically the most responsive to DMARD treatment in the early stages, so the sooner the treatment begins the more beneficial the treatment will be for the patient.

Examples of DMARDs are methotrexate (Rheumatrex), azathioprine (Imuran), cyclosporine (Sandimmune, Neoral), penicillamine (Cuprimine), gold salts (Ridaura, Solganal, Aurolate, Myochrysine), hydroxychloroquine (Plaquenil), leflunomide (Arava), minocycline, sulfasalazine (Azulfidine), and cyclophosphamide.

Although certain DMARDs have proven themselves effective in treating RA, the potential side effects can be very serious.  Some of the side effects of using DMARDs in the long run are increased susceptibility to infections, liver and bone marrow toxicity, allergic skin reactions, and autoimmunity.

Of the DMARDs listed above, hydroxychloroquine is the one with the least potential to cause liver and bone marrow toxicity, and for this reason is often considered to be one of the safer DMARDs.  The downside of this is that hydroxychloroquine is not a very powerful drug, and on its own it’s not strong enough to suppress the symptoms.

On the other hand, methotrexate is often considered to be the best DMARD to use due to several reasons.  It is effective in controlling RA and yet does not cause as much liver and bone marrow toxicity as some of the other DMARDs.  Also, because methotrexate works effectively and safely in combination with biological agents (another group of arthritis medications discussed below), it is often prescribed along with biological agents in cases where it fails to adequately treat RA on its own.  Although not as harmful as some of the other drugs in its class, methotrexate still does have the potential to cause hepatitis or suppress bone marrow, and for this reason regular blood tests must be regularly conducted to monitor the patient, and treatment needs to be stopped upon discovery of the first signs of harm.

Biological Agents

Also referred to as biologic drugs, biological agents act to reduce inflammation via various means.

One way of reducing inflammation is by blocking tumor necrosis factors (TNFs).  Examples of tumor necrosis factor blockers are etanercept (Enbrel), infliximab (Remicade), and adalimumab (Humira).

Another way to reduce inflammation is to destroy B cells.  Rituximab (Rituxan) does exactly that – binds itself to B cells and kills them.
Other drugs that reduce inflammation in their own ways are:
- anakinra (Kineret), which blocks interleukin 1 (IL-1)
- tocilizumab (RoActemra, Actemra), which blocks interleukin 6 (IL-6)
- abatacept (Orencia), which blocks T-cells

Each biological agent has its own specific list of side effects that should be considered before it is prescribed to any particular patient.

Salicylates

These drugs act to decrease the production of prostaglandins, which cause pain and inflammation.  Over the past years they have largely been replaced by NSAIDs, mainly due to serious side effects such as their potential to decrease kidney function.

Pain Relief Medications

Lastly, many RA patients take medications that has the sole purpose of relieving pain, such as acetaminophen (e.g. Tylenol) and tramadol (Ultram).  Although they neither reduce inflammation nor curbs the progress of joint damage, they help the patient to feel more comfortable which allows them to function better in their daily lives.  For this reason they deserve to be mentioned.

If medications are ineffective, doctors may prescribe surgery such as joint replacement (also called arthroplasty, where the damaged portions of the joint are replaced with plastic prosthesis), tendon repair, or joint lining removal (called synovectomy).  Read our article on Arthritis Knee Surgery here.