Medications for Rheumatoid Arthritis

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Common names include:

• Naproxen]]> (Naprosyn, Anaprox, Aleve)
• ]]>Ketoprofen]]> (Orudis)
• ]]>Ibuprofen]]> (Motrin, Advil, Nuprin)
• ]]>Indomethacin]]> (Indocin)
• ]]>Sulindac]]> (Clinoril)
• ]]>Meclofenamate]]> (Meclomen)
• ]]>Ketorolac]]> (Toradol)
• ]]>Piroxicam]]> (Feldene)
• Diclofenac sodium (Voltaren)

Although some nonsteroidal anti-inflammatory agents (NSAIDs) are available as over-the-counter medicines, you may still be given a prescription in order to obtain a higher dosage. NSAIDs help decrease inflammation, swelling, and joint pain.

Be sure to take NSAIDs with food to decrease the chance of stomach irritation.

Drinking alcoholic beverages or taking other NSAIDs, COX-2 inhibitors, aspirin, or steroids while you’re already using an NSAID can increase your risk of side effects.

Possible side effects include:

• Stomach upset
• Stomach ulcers
• Kidney damage
• Liver inflammation
• Confusion, dizziness, lightheadedness
• Severe allergic reaction (hives, difficulty breathing, swelling around the eyes)
• Increased risk of bleeding; always inform your doctors that you’re taking an NSAID before having any medical or dental procedures or surgeries
• Asthma
• Possible increased risk of heart attack

Cyclooxygenase-2 or COX-2 Inhibitors

Common names include:

• Celecoxib]]> (Celebrex)
• ]]>Meloxicam]]> (Mobic)

COX-2 inhibitors work in a way similar to NSAIDs, helping to decrease inflammation, swelling, and joint pain. The way the medicines do this, however, allows them to work without causing the same degree of stomach irritation. In particular, COX-2 inhibitors cause far fewer stomach ulcers than do NSAIDs. But because there is an increased risk of heart attacks and strokes associated with these medicines, doctors generally reserve them for use in people who cannot take traditional NSAIDS and who have no risk factors for cardiac disease.

Drinking alcoholic beverages or taking NSAIDs, aspirin, or steroids while you’re using a COX-2 inhibitor can increase your risk of side effects.

Possible side effects include:

• Stomach upset
• Liver inflammation
• Confusion
• Severe allergic reaction (hives, difficulty breathing, swelling around the eyes)
• Kidney disease
• Congestive heart failure
• Asthma

Disease-modifying Antirheumatic Drugs (DMARDs)

Common names include:

• D-penicillamine]]> (Cuprimine, Depen)
• Hydroxychloroquine sulfate ( ]]>Plaquenil]]> )
• ]]>Methotrexate]]> (Rheumatrex)
• ]]>Cyclophosphamide]]> (Cytoxan)
• ]]>Cyclosporine]]>
• ]]>Azathioprine]]> (Imuran)
• ]]>Leflunomide]]> (Arava)

These drugs are given in an effort to slow or halt the progression of rheumatoid arthritis. They are all immunosuppressive agents. Because rheumatoid arthritis is believed to be caused by an overactive immune system, it is hoped that calming the immune system’s activity will slow the progression of rheumatoid arthritis.

Possible side effects include:

• Nausea
• Diarrhea
• Liver inflammation
• Bladder inflammation
• Kidney damage
• Nerve damage
• ]]>High blood pressure]]>
• Infections
• Lung inflammation
• Muscle and nerve inflammation

Corticosteroids

Common names include:

• Prednisone (Deltasone, Cortan)
• Methylprednisolone]]> (Medrol)

Corticosteroids are very potent anti-inflammatory agents and are given to reduce swelling, inflammation, and joint pain.

Possible side effects for short-term use (about three weeks or less) include:

• Difficulty sleeping
• Increased appetite
• Mood swings, increased emotionality
• Increases in blood pressure
• Increased blood sugar (especially in people with diabetes)

Possible side effects for long-term use (about three weeks or longer) include:

• Weakening of the immune system and an increased risk of developing infections
• ]]>Osteoporosis]]>
• ]]>Cataracts]]>
• ]]>Glaucoma]]>
• Indigestion, ]]>gastritis]]>

Biologic Response Modifiers

• TNF-inhibitors, such as:
  • Etanercept]]> (Enbrel)—restricted in the US
  • ]]>Infliximab]]> (Remicade)
  • ]]>Adalimumab]]> (Humira)
  • ]]>Golimumab]]> (Simponi)
  • ]]>Certolizumab]]> (Cimzia)
• Interleukin-1 receptor inhibitors— ]]>anakinra]]> (Kineret)
• Biologic response modifier and disease-modifying antirheumatic drug (DMARD)— ]]>abatacept]]> (Orencia)
• Monoclonal antibody— ]]>rituximab]]> (Rituxan)
• Interleukin-6 receptor antagonist— tocilizumab (Actemra)

These medicines are given when other drugs haven’t worked. Etanercept, adalimumab, and anakinra are given by injection. Infliximab, orencia and rituximab are given by IV infusions. They can help decrease the symptoms of rheumatoid arthritis. They may also increase your risk of contracting infections. You need to inform your healthcare provider that you are taking these medicines before you get any immunizations. Also TNF-inhibitors can increase the risk of ]]>Hodgkin’s]]> and ]]>non-Hodgkin’s lymphoma]]> and other types of cancer in children and adolescents.

Before you start taking any of these medicines, you’ll need a TB test to make sure you don’t have a hidden case of tuberculosis. You’ll need to have your heart monitored while you take this medicine. Contact your healthcare provider immediately if you develop any of the following symptoms after receiving one of these medicines:

• Chest pain
• Difficulty breathing
• Fever and chills
• Productive cough
• Itching
• Hives
• Flushed face
• Rashes
• Confusion
• Weakness
• Injection site reactions

Acetaminophen]]>

Common brand names include:

• Actamin
• Banesin
• Tylenol

Acetaminophen can be helpful in relieving some of the pain associated with rheumatoid arthritis. Do not take a larger dose than is recommended by your healthcare provider. Do not drink alcoholic beverages while you are taking acetaminophen.

Capsaicin Cream

Common brand name: Zostrix]]>

Capsaicin cream is rubbed on the skin of an affected joint to relieve the pain and inflammation of rheumatoid arthritis.

It’s made using the active ingredient of hot chili peppers. Some people prefer to wear rubber gloves while applying the cream. If you don’t, be sure to wash your hands very thoroughly with soap and water after using the cream. Be very careful not to get the cream near your eyes, as it will burn and sting. If you do get some in your eyes, flush them thoroughly with cool water.

Possible side effects include burning, stinging, or warm sensation when first applied to the skin.