Medications for rheumatoid arthritis

Being prescribed the right medication is an important part of managing your arthritis. There are many different medications available to control the symptoms of rheumatoid arthritis and to stop the disease progressing.

For most people with rheumatoid arthritis, the benefits of medication far outweigh any possible side effects. It is helpful to understand the different types of medication available. The earlier treatment starts, the better.

Your health professional will offer ongoing advice about your treatment. To gain maximum benefit it is important to follow this advice and to regularly discuss how well your treatment is working and what symptoms and pain you are experiencing. Treatment is tailored to the needs of each individual.

Painkillers

Painkillers, also known as analgesics, are medicines that relieve pain. They are advised as a ‘top-up’ treatment for relieving pain, together with other medications. Paracetamol is often given or paracetamol with codeine (in the form of the combination tablet, co-codamol). Sometimes stronger painkillers such as tramadol are given to relieve the symptoms. The most common side-effect of analgesics is constipation. Other painkillers include dihydrocodeine and co-proxamol.

Corticosteroids

Corticosteroids may be used to control inflammation flare-ups. These are man-made substances based on a natural hormone produced in the body, cortisone. They can be administered by injection into the inflamed joint, a vein or muscle or can be taken in tablet form.

However, if used for a long time (ie. many months) or in high doses there may be some long-term side effects. Corticosteroids used to treat arthritis can be a risk factor for osteoporosis, a disease that causes bones to fracture more easily. For this reason your doctor may prescribe treatment to protect your bones while taking steroids, and will monitor you carefully. Prednisolone is the most common corticosteroid.

Non-steroidal anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs (NSAIDs) reduce both pain and inflammation. Aspirin was the original NSAID. They do not, however, stop the damage in your joints from occurring. There are now about 20 different varieties available in Ireland and your doctor will chose the more appropriate one for you. If one type does not work, your doctor may try another. Examples are ibuprofen, naproxen, etodolac.

NSAIDs are usually given by mouth but may also be given by suppository or in slow-release preparation. ‘Slow-release’ means that the body gradually absorbs the medication a little at a time, rather than all at once. The side effects of NSAIDs are that may cause indigestion and there is a risk of stomach bleeding. Therefore, your doctor may prescribe another type of drug with the NSAID to reduce the risk of stomach problems. This is called a proton pump inhibitor, which helps to reduce indigestion and to protect the stomach.

A newer type of NSAID was introduced more recently which had less impact on the stomach and was hailed as a step forward. However, there was concern about heart problems caused by this newer drug.

Disease-modifying anti-rheumatic drugs (DMARDs)

This group of medications not only treat symptoms over time, but also reduce the effects of the disease by slowing down the effects of RA on joints. In recent years they have proved an important part of rheumatoid arthritis treatment and many people take them for several years.

DMARDs also reduce pain and stiffness by tackling inflammation. They may not work immediately and it may take several weeks before the effects are felt. They can reduce the progression of joint damage if started early enough in the disease. However, they cannot fix joint damage that has already occurred.

There are a number of DMARD treatments available in Ireland. Methotrexate, which acts to suppress the immune system is a common one. The side effects associated with methotrexate include nausea and indigestion. Other examples are gold therapy, sulfasalazine and leflunamide. Regular blood and urine tests are often needed when individuals are on some DMARDs .

Biologic drugs

The most recent development in the treatment of rheumatoid arthritis has been the use of biologic drugs. These drugs come from substances that occur naturally in our bodies – they do not come from chemicals – and are made using biotechnological techniques such as DNA manipulation and cell culture.

The major advantage of these drugs is that they are very targeted. They act directly on the processes that lead to inflammation and joint damage. At present they are used to treat individuals with severe disease after other arthritis drugs have failed to make an impact.

They are usually administered by injection or by intravenous (IV) therapy (i.e. directly into the veins via a drip) in hospital. People who are suitable to take them, are strictly monitored. Biologics are often used along with other arthritis medications.

Examples include: abatacept, adalimumab, anakinra, etanercept, infliximab, rituximab and tocilizumab.