Rheumatoid Arthritis Medications
Painkillers, Steroid Injections And Biologic Drugs

Rheumatism drugs


Rheumatoid Arthritis Drugs


What Medications Will I Need To Take?
List Of Medications
What Is Considered A Remission?

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What Medications Will I Need To Take?

If you have received a rheumatoid arthritis diagnosis, the following is a general guideline of what medications you can expect to take in the first year.

First signs: Make an appointment with your doctor when you experience the first symptoms of rheumatoid arthritis. He will diagnosis the condition based on a number of tests and by ruling out other potential causes like fibromyalgia or Sjogrens syndrome. You may be taking over the counter painkillers like ibuprofen or aspirin to help you cope with aching joints.
Within 2 months: A disease-modifying antirheumatic drug (DMARD) called methotrexate will be prescribed. This is considered the gold standard for treating rheumatoid arthritis. As methotrexate takes one or two months to kick in, you may also be told to take a nonsteroidal anti-inflammatory drug (NSAID) such as aspirin or ibuprofen to control pain in the meantime.
Within 6 months: If methotrexate is not working at this stage you might be switched to another DMARD. Or, your doctor may add a stronger medication called a biologic drug. Liver function tests will be done monthly or every two months if you are taking methotrexate, Arava or Remicade; and periodically if you take cyclosporine. You will need a yearly test if you take NSAIDs or salicylates.
By year 1: If tests and a physical examination show that your disease has progressed to joint damage, your doctor may increase the dosage of your meds.

List Of Medications

There are lots of different drugs prescribed to patients with RA. Some are taken to ease symptoms; others are taken to halt the progression of disease. Most fall into the following categories:

Drug Brands Side Effects
NSAIDs (Painkillers and Anti-Inflammatories)
Nonsteroidal anti-inflammatory drugs (NSAIDs). These include over a dozen different meds – some can be bought over the counter, others require a prescription. They help to ease pain and inflammation. Low doses help to reduce muscles aches and headaches. Higher prescription doses will ease inflammation. NSAIDs fall into 3 basic categories: traditional NSAIDs, COX-2 inhibitors and salicylates. Traditional NSAIDs like Ibuprofen are available in low doses over the counter. COX-2 (prescription only) are designed to be safer on the stomach. Salicylates (includes aspirin) are still preferred by some doctors and patients for occasional aches.
Interesting note: Many branded ‘arthritis pills’ are simply repackaged aspirins or regular NSAIDs - for which manufacturers charge a premium.
The most commonly taken NSAIDs are naproxen (Naprosyn), ibuprofen (Advil, Motrin), ketoprofen (Actron, Orudis KT) and naproxen sodium (Aleve).

Some patients are showing benefits from using more recently introduced COX-2 inhibitors (Mobic and Celebrex). These medications can moderately reduce pain and also act to combat muscle inflammation.

Salicylates are the original category of NSAIDs, and include aspirin. Salicylates are still preferred by many patients and doctors.
The main problem with NSAID's is that they can cause stomach upsets, so they should be taken with a meal. Some people take Rolaids or Tums to counteract the effect. Other possible side effects if they are taken long-term include stuffy nose, rapid heartbeat, blurred vision and dizziness. For this reason they are not considered a long-term solution but rather a short-term method for coping with flare-ups.

All NSAIDs, including COX-2, increase the risk of stroke in women, so those with heart problems should avoid taking them.
Corticosteroid Injections
Steroids are injected directly into an inflamed joint (by a rheumatologist doctor) and can give instant relief during a painful flare up. They are strong, quick acting anti-inflammatory drugs. They can be used to keep potentially damaging inflammation under control while waiting for the effects of DMARDs to kick in.
Prednisone, prednisolone and methyprednisolone injections.
If taken over a long period of time steroids can cause side effects. High dosages may cause osteoporosis, diabetes, high blood pressure and weight gain. Talk to your doctor about ensuring you receive the lowest dosage as possible.
Non-Biologic DMARDs
Disease-modifying antirheumatic drugs, DMARDs. These medications work slowly to change (modify) the course of your disease. They act by preventing the immune system from attacking the joints, thus halting the progression of the disease. However they have to be carefully monitored because of possible side effects.
The most commonly used DMARD for RA is methotrexate (Matrex). Others include hydroxychloroquine (Plaquenil), leflunomide (Arava), sulfasalazine (Azulfidine, Azulfidine EN-Tabs) and azathioprine (Imuran).
DMARDs suppress the immune system (they are supposed to), but it means you become more vulnerable to other infections. Be aware of signs of infections such as coughs, fever, chills and sore throat and report them to your doctor. Always check with your doctor before getting any vaccinations.
Biologic Agents (Injectable Biologic DMARDs)
Biologic drugs are the newest type of medications in the treatment of RA. They are usually only considered where non-biologic DMARDs have failed to halt the progress of RA. Between 40 and 70 percent of those who have not benefited from other RA meds experience some measure of relief from biologics. Biologic agents block a specific step in the inflammation process. For example Enbrel and Remicade block the action of a chemical called Tumor Necrosis Factor (TNF), thought to be linked to inflammation. Thus, these drugs are called anti-TNFs. As biologics are very expensive they are not prescribed very regularly (average treatment costs $2,000 per month).
Currently there are 6 biologic agents approved for treating RA: abatacept (Orencia), anakinra (Kineret), etanercept (Enbrel), adalimumab (Humira),rituximab (Rituxan) and infliximab (Remicade). All agents need to be injected. Some on a daily basis, others on a weekly, monthly or bi-annual basis.
97 percent of patients experience at least one side effect. This can range from mild to life threatening. Serious side effects include cancer, allergic reactions, damage to red blood cells and tuberculosis. Rituxan seems to produce the most side effects.

What Is Considered A Remission?

You have experienced a remission if:

• You experience less than 15 minutes of stiffness in the morning.
• Have no tender or swollen joints for at least 3 months.

According to experts, half of patients receiving newer forms of rheumatoid arthritis treatment (and even older treatments such as methotrexate) should experience a remission. One 2-year study (Trial of Etanercept and Methotrexate with Radiographic Patient Outcomes) reported over 75 percent of people treated with Enbrel (biologic), plus methotrexate experienced no worsening of joint damage over 3 years. Furthermore, 40 percent experienced a remission of symptoms.

Advice: If you continue to experience RA symptoms, work with your doctor for a solution. This may mean increasing your dosage or trying another drug. Don't take no for an answer.

  Related Articles on Rheumatism

For more advice, see the following:

Arthritis Treatment: Treatments for different types of arthritis.
Risk Factors For Rheumatoid Arthritis: Genetics, periods, smoking.
Bone and Joint Problems: Symptom checker.

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