Even though there is no actual treatment for rheumatoid arthritis (RA) to this day, there are a number of available medications in pharmacies that are designed to manage its symptoms and eventually improve the patient’s condition.
In general, rheumatoid arthritis medications can be grouped into different classes, as discussed in the following paragraphs. Physicians will probably recommend an appropriate plan for treatment to reduce inflammation and pain of the joints, and avert damage to the joints. Depending on each case, the most effective treatment can be accomplished by combining these options:
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
Nonsteroidal Anti-inflammatory Drugs, otherwise known as NSAIDs, work as an anti-inflammatory and in pain relief, but don’t function to protect the joints from further damage. These drugs block the body from producing a substance called prostaglandins, which which sets off inflammation & pain.
Some examples of NSAIDs are naproxen (Aleve and Naprosyn) and ibuprofen (Advil and Motrin). Other NSAID examples include etodolac (Lodine), meloxicam (Mobic), ketoprofen (Orudis), Celecoxib (Celebrex), indomethacin, oxaprozin (Daypro), diclofenac (Voltaren, Cataflam), piroxicam (Feldene), and nabumetone (Relafen).
These drugs are commonly advised as soon as a positive RA diagnosis is made. But remember that when consumed in extreme dosages for extended periods, these medications can cause severe side effects, including gastric ulcers, stomach bleeding, plus liver and kidney damage.
Corticosteroids
A different group of medication used for rheumatoid arthritis treatment is corticosteroids. Such medications impact the immune system, ultimately managing inflammation.
Methylprednisolone (SoluMedrol, DepoMedrol), betamethasone (Celestone Soluspan), Cortisone (Cortone), prednisolone (Delta-Cortef), triamcinolone (Aristocort), dexamethasone (Decadron), and prednisone (Deltasone & Orasone), are some of the most common corticosteroids.
Although corticosteroids can be effective in rheumatoid arthritis treatment, they have been known to trigger negative side effects if used in extended periods. Examples of such side effects include glaucoma, easy bruising, cataracts, diabetes, excessive weight gain, and thinning bones.
Given these risks of adverse side effects, these drugs are often only used as a temporary solution to curtail sudden RA attacks. The good news is that one single corticosteroid injection can inhabit inflammation of the joint lasting for a long period of time.
Disease Modifying Anti-Rheumatic Drugs (DMARDs)
Disease Modifying Anti-Rheumatic Drugs or DMARDs pertain to a classification of drugs that serve to inhibit your immune system from assaulting the joints, gradually obstructing further progression of joint damage. In rheumatoid arthritis treatment, these drugs are commonly consumed in combination with other drugs for more successful results.
RA causes permanent joint damage, which becomes apparent in the early stages of the disease. Accordingly, the majority of physicians would recommend DMARDs soon after diagnosis. You are most responsive to DMARDs during the initial stages of rheumatoid arthritis. The earlier the medication is taken, the more effective it is for the individual.
DMARD examples include methotrexate (Rheumatrex), cyclosporine (Sandimmune, Neoral), hydroxychloroquine (Plaquenil), gold salts (Solganal, Aurolate, Myochrysine, Ridaura), cyclophosphamide, azathioprine (Imuran), penicillamine (Cuprimine), minocycline, sulfasalazine (Azulfidine), and leflunomide (Arava).
Though a number of DMARDs have been proven effective in RA treatment, the potential for severe side effects is high. Using DMARDs for a long time can lead to toxicity of the liver and bone marrow, susceptibility to infections, allergies (particularly of the skin), and autoimmunity.
Of the DMARDs previously listed, hydroxychloroquine has the lowest risk of causing liver and bone marrow toxicity, and is hence deemed to be one of the safest DMARD types. Unfortunately, hydroxychloroquine is by no means an especially powerful medication and is not effective enough on its own to alleviate rheumatoid arthritis symptoms.
Conversely, methotrexate is believed to be one of the most powerful DMARDs in treating RA due to a number of reasons. It has been documented to work in RA treatment without affecting the toxicity of the liver and bone marrow as in the majority of DMARDs. Moreover, methotrexate has been proven safe and effective when used in combination with biological agents, another type of RA drugs to be discussed later. Therefore, it is commonly recommended for use with some biological agents in cases where the drug fails to manage the condition on its own. But please note while methotrexate is not as potentially dangerous as others, it still canhinder the bone marrow or set off hepatitis. In such cases, getting regular blood tests are recommended to guide the individual’s condition, and to stop treatment at the first indication of problems.
Biological Agents
Biological agents or biological drugs serve to reduce inflammation via different ways.
One example of how biological drugs work is by inhibiting tumor necrosis factors (TNFs). Infliximab (Remicade), adalimumab (Humira), and etanercept (Enbrel) are some TNF blockers.
Another method of how biological agents curtail inflammation is by eradicating B cells. Rituximab (Rituxan), for instance, binds itself to B cells, hence destroying them.
Further medications that reduce inflammation in their own distinctive ways are:
- tocilizumab (e.g. Actemra and RoActemra), serves to inhibit IL-6 or interleukin – anakinra (e.g. Kineret), serves to inhibit interleukin 1 or IL-1 – abatacept (i.e. Orencia), which works by inhibiting T-cells
One thing to consider is that every of these biological drugs has its own potential for negative side effects. The risks for side effects must be considered when giving it to any individual.
Salicylates
Salicylates function by reducing prostaglandins production in the human body. Prostaglandins are the cause of arthritis inflammation and pain. In recent times, salicylates have been generally replaced with nonsteroidal anti-inflammatory drugs (NSAIDs), mainly since salicylates can cause serious side effects, including potential damage to the kidney.
Pain Relief Medications
Lastly, various pain relief drugs can likewise be taken in rheumatoid arthritis treatment. Examples of pain relief medications are acetaminophen (Tylenol) and tramadol (Ultram).
Although pain relief drugs neither alleviate inflammation nor avoid the progression of joint damage, these medications allow the individual achieve a sense of comfort and in due course function better in his/her daily life. Hence, anti-pain drugs are definitely worth mentioning.
Surgery as a Last Resort
If all the medications discussed previously fail to produce results, a physician may probably recommend surgical treatment. Some surgical procedures used in RA treatment are tendon repair, joint lining removal (i.e. synovectomy), as well as arthroplasty (joint replacement surgery), wherein the damaged parts of the joint are replaced with prosthetics.