What Drugs are Used to Treat Rheumatoid Arthritis?
What is rheumatoid arthritis?
Arthritis is a general term that describes inflammation in joints. Rheumatoid arthritis is a type of chronic (ongoing) arthritis that occurs in joints on both sides of the body (such as both hands, wrists, and knees). This symmetry helps distinguish rheumatoid arthritis from other types of arthritis.
In addition to affecting the joints, rheumatoid arthritis may occasionally affect the skin, eyes, lungs, heart, blood, nerves, or kidneys.
What are the goals of treating rheumatoid arthritis?
The most important short-term goal of treatment is to reduce joint inflammation. Joint pain and swelling improve once joint inflammation is reduced.
The long-term goal of treatment is to slow or stop joint damage, which can be seen on X-rays. Once joint inflammation is controlled, pain will be reduced.
| Normal joint  | Joint afftected by rheumatoid arthritis  |
Changing philosophy about drugs
In the past, many doctors did not believe that drugs for rheumatoid arthritis changed the likelihood of eventual disability from the disease. Therefore, drugs with the least side effects were prescribed to decrease pain. Stronger drugs were avoided because of doctors’ concerns about dangerous side effects.
Now, however, doctors know that early treatment can improve the long-term outcome for most patients. Newer drugs that have proven to be effective are being used soon after the patient is diagnosed. Combinations of drugs are proving to be more effective and, in recent studies, just as safe as single drug treatment.
What drugs are used to treat rheumatoid arthritis?
The drugs used to treat rheumatoid arthritis can be divided into two groups:
Drugs that decrease pain and local inflammation, including aspirin and non-steroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen or naproxen Drugs that decrease pain and inflammation while decreasing the growth of abnormal synovial tissue (the tissue that lines the inside of the joint). These drugs include methotrexate and low doses of corticosteroids (such as prednisone or cortisone). In some people, these drugs also decrease joint destruction. Other medications used to treat rheumatoid arthritis include: anti-malarial medications (such as hydroxychloroquine), gold, sulfasalazine, penicillamine, cyclophosphamide, cyclosporin, and minocycline. Sometimes, more than one drug may be prescribed.
Newer biologic agents that block the effects of specific inflammatory factors (cytokines) are now available. Infliximab, etanercept and adalimumab block the cytokine anti-tumor necrosis alpha, and anakinra blocks the cytokine interleukin-1. These agents are somewhat more effective than previous medicines and can be combined with them, especially with methotrexate.
How well do the drugs work?
All the drugs used to treat rheumatoid arthritis have been tested and have been proven useful in patients who have the disease.
All of the NSAIDs are similarly effective, making it difficult for doctors to strongly recommend one over the other.
Methotrexate is among the drugs that are most effective in providing long-term benefits for people with rheumatoid arthritis.
Are the drugs dangerous?
The effectiveness and the risks of drugs are considered when your rheumatologist plans your treatment.
If a drug is very effective in treating an illness but causes a lot of side effects, it is not an ideal treatment. For example, high doses (15 to 20 mg or more per day) of corticosteroids can make people with rheumatoid arthritis feel dramatically better. However, high doses of corticosteroids may cause serious side effects when taken over many months or years.
In addition, NSAIDs are no more effective than full doses of uncoated aspirin, yet they are often prescribed because they are not as irritating to the stomach. Coated aspirin, such as Ecotrin®, is much less irritating to the stomach than the same uncoated medicine.
What are some of the side effects of the drugs?
Since no drug is entirely safe, your doctor will talk to you about the possible benefits from the drugs as well as the risks and side effects. The occurrence of side effects depends on the dose, type of medication, and length of treatment.
Some of the side effects of each type of drug used to treat rheumatoid arthritis are listed below.
PLEASE NOTE: The following side effects are the most common. All possible side effects are not included. Always contact your doctor if you have questions about your personal situation.
