Rheumatoid Arthritis Medications - written by Amy Clark

Although there is no actual cure for rheumatoid arthritis (abbreviated as RA) at present, there are a number of available medications in the market that are meant to manage its symptoms and ultimately improve the condition.

Overall, rheumatoid arthritis medications may be categorized into different classes, as discussed later in this article. Doctors can recommend an appropriate plan for treatment to alleviate inflammation and pain of the joints, plus avert joint damage. Depending on the specific case, successful treatment can be achieved by combining these options:

Nonsteroidal Anti-inflammatory Drugs, a.k.a. NSAIDs

Nonsteroidal Anti-inflammatory Drugs, otherwise known as NSAIDs, work in relieving pain and reducing inflammation, but do not serve to prevent further damage to the joints. These drugs prevent your body from the production of prostaglandins, which triggers pain and inflammation.

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

NSAIDs are frequently recommended when a definite RA diagnosis is made. But remember that when consumed in high doses for prolonged periods, these medications can cause adverse side effects, like stomach bleeding, gastric ulcers, and even potential damage to the kidney and liver.

Corticosteroids

One more classification of RA medication is corticosteroids. Such medications restrain the immune system, thus managing inflammation.

Cortisone (Cortone), methylprednisolone (SoluMedrol, DepoMedrol), betamethasone (Celestone Soluspan), prednisolone (Delta-Cortef), dexamethasone (Decadron), triamcinolone (Aristocort), as well as prednisone (Orasone and Deltasone), are some of the most common corticosteroids.

Although corticosteroids are successful in treating rheumatoid arthritis, they are said to trigger severe side effects when used in extended periods. Examples of such side effects include easy bruising, glaucoma, cataracts, diabetes, excessive weight gain, and thinning bones.

Owing to the risks of severe side effects, these drugs are commonly only used as a momentary solution to curtail sudden outbreaks of the disease. The good news is that just one injection of corticosteroids can block joint inflammation lasting for an extended period.

Disease Modifying Anti-Rheumatic Drugs or DMARDs

Disease Modifying Anti-Rheumatic Drugs or DMARDs are a type of drugs that work to inhibit your immune system from damaging the joints, eventually hindering further progression of joint damage. In RA treatment, disease modifying anti-rheumatic drugs are frequently taken on top of other drugs for a more successful outcome.

Rheumatoid arthritis often causes permanent damage to the joints, which manifests in the early stages of the disease. Consequently, most doctors would recommend DMARDs soon after diagnosis. You are most receptive to DMARDs in the initial stages of rheumatoid arthritis. The sooner the drug is consumed, the more advantageous it is for the RA patient.

Common DMARD examples include hydroxychloroquine (Plaquenil), methotrexate (Rheumatrex), cyclosporine (Sandimmune, Neoral), gold salts (Solganal, Aurolate, Myochrysine, Ridaura), cyclophosphamide, azathioprine (Imuran), penicillamine (Cuprimine), sulfasalazine (Azulfidine), leflunomide (Arava), and minocycline.

Although various DMARD products have been successful in treating RA, the potential for negative side effects is alarming. Long-term DMARD consumption can set off bone marrow and liver toxicity, susceptibility to infections, allergies (e.g. skin), as well as autoimmunity.

Among the DMARDs previously mentioned, hydroxychloroquine has the lowest potential for causing bone marrow and liver toxicity, and is therefore believed to be one of the safest DMARDs to use. On the other hand, hydroxychloroquine is apparently not powerful medication by itself and is not strong enough on its own to manage rheumatoid arthritis.

Conversely, methotrexate is believed to be one of the most powerful DMARDs to use in rheumatoid arthritis treatment due to various factors. Methotrexate has been documented to effectively fight RA without affecting the toxicity of the bone marrow and liver as in the majority of DMARDs. Further, it has been proven effective and safe when used together with biological agents, which are another group of RA drugs discussed below. Consequently, these drugs are frequently recommended together with biological agents in cases where the drug does not control RA on its own. But then again, keep in mind that although methotrexate is not as risky as other DMARDs, it still has the ability to obstruct the bone marrow or set off hepatitis. If this happens, getting regular blood tests are recommended to monitor one's condition, as well as to cease treatment at the first sign of complications.

Biological Agents

Biological agents, also known as biological drugs, serve to lessen inflammation through a range of methods.

An example of how biological agents work is by inhibiting TNFs (tumor necrosis factors). Infliximab (Remicade), etanercept (Enbrel), and adalimumab (Humira) are TNF blockers.

One other method of how biological agents curtail inflammation is through killing B cells. The Rituxan (Rituximab) drug, for instance, binds itself to B cells, hence killing them.

Other medications that alleviate inflammation through their own way are:

- tocilizumab (e.g. Actemra, RoActemra), functions by blocking IL-6/interleukin
- anakinra (e.g. Kineret), blocks interleukin 1 (IL-1)
- abatacept (i.e. Orencia), works by blocking T-cells

Bear in mind that each of these biological agents has its own potential for side effects. A drug's side effects must be considered when prescribing it to any patient.

Salicylates

Salicylates reduce prostaglandins production in the human body. Prostaglandins are the source of the inflammation and pain of arthritis. Recently, the use of salicylates have been widely replaced with nonsteroidal anti-inflammatory drugs (NSAIDs), mainly because salicylates can cause adverse side effects, like causing potential kidney damage.

Pain Relief Medications

Last but not least, a variety of pain relief medications can likewise be taken in treating RA. Some pain relief medications include tramadol (Ultram) and acetaminophen (Tylenol).

While anti-pain drugs neither curtail inflammation nor suppress joint damage progression, they allow the individual achieve a sense of comfort and eventually function better. For this reason alone, anti-pain drugs are certainly worth mentioning.

Surgery as a Last Resort

If all the medications discussed previously do not produce results, physicians may probably recommend surgery. Examples of surgeries meant to treat rheumatoid arthritis include tendon repair, joint lining removal (synovectomy), and arthroplasty (i.e. joint replacement surgery), wherein the damaged joint is replaced with prosthetics.