Medications

Medicines are the main treatment for rheumatoid arthritis. The types of medicines used depend on how severe your disease is, how fast it is progressing, and how it affects your daily life.

If your symptoms ease, you and your doctor will decide if you can take less medicine or stop taking medicine. If your symptoms get worse, you will have to start taking medicine again.

Medicines are used to:

• Relieve or reduce pain.
• Improve daily function.
• Reduce joint inflammation. Signs of joint inflammation include swelling, tenderness, and limited range of motion.
• Prevent or delay significant joint damage and deformity.
• Prevent permanent disability.
• Improve quality of life.

Medicines called disease-modifying antirheumatic drugs (DMARDs) can slow or sometimes prevent joint destruction. Starting treatment early with DMARDs can reduce the severity of the disease.³ DMARDs are also called immunosuppressive drugs or slow-acting antirheumatic drugs (SAARDs). These medicines work best when taken over a long period to help control the disease.⁸

DMARDS can be divided into two general categories based on how they work: oral DMARDs and biologic DMARDs. Oral DMARDS are taken by mouth. They interfere with the making or working of immune cells that cause joint inflammation. Biologic DMARDS are given by injection (infusion). They act in several different ways to affect how immune cells work. DMARDs decrease joint inflammation and damage.

Medicines may be given together. This is called combination therapy. Oral medicines are combined with each other or with biologic DMARDs. But biologic DMARDs are not used with each other because of a higher risk of infection. By combining medicines, you may be able to take lower doses of individual medicines. This may reduce your risk of side effects.

Some medicines for rheumatoid arthritis may cause birth defects. If you are pregnant or are trying to become pregnant, talk with your doctor about your medicines.

Medication Choices

Medicines to slow the disease

Disease-modifying antirheumatic drugs (DMARDs) are usually started within 3 months of your diagnosis. They are used to control the progression of RA and to try to prevent joint damage and disability. DMARDs are often given in combination with other medicines.

Commonly used oral DMARDs:

• Antimalarials such as hydroxychloroquine (Plaquenil) or chloroquine (Aralen)
• Leflunomide (Arava)
• Methotrexate such as Rheumatrex
• Sulfasalazine such as Azulfidine

Less commonly used oral DMARDs:

• Azathioprine such as Imuran
• Cyclophosphamide such as Cytoxan
• Cyclosporine such as Neoral or Sandimmune
• Gold salts such as Ridaura or Aurolate
• Minocycline such as Dynacin or Minocin
• Penicillamine such as Cuprimine or Depen

Biologic DMARDs:

• Abatacept (Orencia)
• Adalimumab (Humira)
• Anakinra (Kineret)
• Etanercept (Enbrel)
• Infliximab (Remicade)
• Rituximab (Rituxan)
• Tocilizumab (Actemra), a newer biological DMARD used to treat rheumatoid arthritis that has not responded to other treatment

Medicines to relieve symptoms

• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen. NSAIDs are used to control pain and may help reduce inflammation. They don't control the disease or stop it from getting worse. NSAIDs may be combined with DMARDs.
• Corticosteroids such as prednisone or Medrol. These medicines are used to reduce disease activity and joint inflammation. But using only corticosteroids for an extended time is not considered the best treatment. Corticosteroids are often used to control symptoms and flares of joint inflammation until DMARDs reach their full effectiveness.
• Analgesics (pain relievers). These don't reduce inflammation but may help with pain control. They include:
  • Nonprescription acetaminophen.
  • Acetaminophen with codeine (such as Tylenol with codeine).
  • Acetaminophen with hydrocodone (such as Vicodin).
  • Tramadol.

What to Think About

• Some DMARDs can take up to 6 months to work.
• In some people, a certain DMARD may not work at all. So a different DMARD will be used.
• If you're taking DMARDs, it's a good idea to have a rheumatologist manage your care.
• Many DMARDs have serious side effects. You will need regular blood and urine tests to check the drug's effects on blood-producing cells (bone marrow), the kidneys, and the liver.
• Other medicines are being studied. One example is tacrolimus (Prograf), an inhibitor of a protein called calcineurin. In one 6-month trial, people who had rheumatoid arthritis that had not responded to DMARDs had fewer symptoms.⁹