Drugs and Medications for Rheumatoid Arthritis
Rheumatoid arthritis (RA) has no known cure, but there are many drugs and medications that can help reduce your inflammation and joint pain.
Based on the severity of your rheumatoid arthritis symptoms, your doctor will develop the right medication regimen for you. You will typically exhaust over-the-counter medications before progressing to prescription medications, if necessary.
In this RA Treatment Series
Below are the rheumatoid arthritis drugs and medications, listed in the order they are commonly used.
Over-the-counter medications for RA include:
- Acetaminophen, such as Tylenol, is known as an analgesic. Analgesics are pain killers, but they won't reduce your inflammation. Acetaminophen may cause liver problems with excessive use. If you consume large amounts of alcohol, it will increase this risk.
- Non-steroidal anti-inflammatory drugs (NSAIDs) can help relieve both pain and inflammation, which is how they differ from acetaminophen. Examples of NSAIDs include aspirin and ibuprofen (Advil). Some NSAIDs are not suitable for those who have a history of heart attack or stomach ulcers. These medications should be taken with food to prevent stomach bleeding and pain.
Prescription medications for RA include:
- Corticosteroid drugs, also called oral steroids, are a common part of rheumatoid arthritis treatment regimen because they're highly effective at reducing inflammation. The downside is that over time, the drug becomes less effective because your body adjusts to the anti-inflammatory effect. Decadron and methylprednisone are examples of oral steroids.
Corticosteroids also come with the risk of bone thinning, bruising, weight gain, and high blood pressure.
- COX-2 inhibitors, such as Celebrex, are a newer class of NSAIDs that reduce pain and inflammation but without the risk of stomach complications. These drugs are used mainly by people with moderate to severe rheumatoid arthritis.
- Disease-modifying anti-rheumatic drugs (DMARDs) work differently than corticosteroid drugs. Instead of acting quickly but without a lasting effect, DMARDs slowly modify the disease. So slowly, in fact, that it may take several months for you to feel their effects. That's why doctors often prescribe DMARDs within three months of your diagnosis—so you'll get the benefits as quickly as possible. DMARDs are also usually taken with an NSAID—the NSAID treats the painful symptoms while the DMARD works to prevent joint damage. Methotrexate (Rheumatrex) is among the most prescribed DMARDs.
Many DMARDs come with serious side effects, usually involving blood-producing cells, the kidneys, and the liver. Regular tests are necessary when using a DMARD so your doctor can monitor any possible adverse effects.
- Tumor necrosis factor (TNF)-alpha inhibitors are a newer class of DMARD, commonly known as a biologic agent. TNF-alpha inhibitors "copy" the effects of substances made naturally by your immune system. These medications are often used if traditional DMARDs prove ineffective.
The FDA has approved three TNF-alpha inhibitors to treat moderate to severe cases of rheumatoid arthritis: etanercept (Enbrel), infliximab (Remicade), and adalimumab (Humira). These medications can be used alone but are often used in conjunction with other DMARDs to increase the benefits.
A doctor's supervision is essential while using as TNF-alpha inhibitor, especially if you have an active infection, central nervous system disorder, or exposure to tuberculosis.
- Immunosuppressants can be used to help quiet the immune system. Patients with rheumatoid arthritis have immune systems that aren't functioning properly, and immunosuppressants can help deal with that. Azathioprine (Imuran) is an example of an immunosuppressant.
- Opioid pain relievers, such as oxycodone (OxyContin), alleviate intense pain and should be used in extreme cases. Note that many patients develop tolerance to opioids and require increasingly higher doses to get relief. If you are prescribed an opioid, use it only under doctor supervision because it can be addictive.
- Anti-depressant drugs help reduce chronic pain in a variety of ways. Anti-depressants block pain messages from getting to your brain and increase the effects of endorphins, which are essentially your body's natural pain killers. Another added benefit-anti-depressants help you sleep better.
Medications typically have side effects or adverse interactions with other drugs that you should take into consideration. Discuss all medications—even if they're over-the-counter and pose no apparent risk—with your doctor first.