Prescription medications are among the best ways to manage rheumatoid arthritis. The goal of these drugs is to settle down the disease's activity in order to prevent permanent joint damage, and also to control pain and maximize function. Without medication, only a small minority of people will experience a quieting of inflammation and symptoms.
Several different types of medications can be used to treat rheumatoid arthritis. Which drugs your doctor prescribes will depend on the stage and activity level of your (or a loved one's) rheumatoid arthritis and any other health problems you might have.
Here are the most common types of medications used to treat rheumatoid arthritis:
Disease-modifying antirheumatic drugs (DMARDs)
DMARDs come in two key flavors, "nonbiologic" and "biologic," and are the mainstay of drug treatment for rheumatoid arthritis. They have the potential to prevent permanent damage to the joints, but they often take weeks to provide relief.
Commonly used nonbiologic DMARDs include methotrexate, hydroxychloroquine, sulfasalazine, and leflunomide. Biologic DMARDs include etanercept, infliximab, and rituximab.
DMARDs almost always require careful monitoring for side effects. Read more about DMARDs here.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs include familiar over-the-counter drugs such as ibuprofen and naproxen; other NSAIDs, such as celecoxib, are only available by prescription.
Although NSAIDs do reduce inflammation, they aren't usually strong enough to counter the immune system's attack on the joints. Unlike DMARDs, NSAIDs don't delay or prevent permanent joint damage related to rheumatoid arthritis. For these reasons, NSAIDs are usually only used for extremely mild cases.
Side effects from NSAIDs are common, so older adults in particular should be monitored when taking NSAIDs every day.
Also known as steroids, the most commonly prescribed oral glucocorticoids are prednisone and prednisolone. Glucocorticoids can also be injected into joints.
These drugs work quickly to suppress inflammation and pain and are often used for short-term symptom relief while waiting for a DMARD to take full effect. Although glucocorticoids are stronger anti-inflammatories than NSAIDs, they don't delay or prevent permanent joint damage in rheumatoid arthritis.
Furthermore, longer-term use of glucocorticoids usually causes problematic side effects in most people. These can include weight gain, diabetes, infections, and osteoporosis. For this reason, most people have their dose tapered down within weeks or months, and doctors generally strive to use the lowest dose possible.
These drugs help decrease pain but don't actually reduce inflammation in the body. Commonly used analgesics include acetaminophen, tramadol, and topical creams such as capsaicin. Occasionally, stronger opiate medications like hydrocodone or oxycodone may also be used.
Which medications should I be on?
Unfortunately, there's no easy answer to this question because treatment for rheumatoid arthritis is always tailored to the individual person. Things to consider:
The stage and activity of the RA
Potential side effects of the medications being considered
Medications you've tried in the past, and how well they worked
Other ongoing illnesses or chronic conditions
In general, most people with rheumatoid arthritis receive a disease-modifying antirheumatic drug (DMARD) as part of their treatment, since this is one of the best ways to prevent permanent damage to the joints.
For more on DMARDs, click here.
For ways to complement the medication treatment of rheumatoid arthritis, click here.