Rheumatoid Arthritis Drug Guide


 

Rheumatoid arthritis (RA) is a progressive inflammatory disease that affects the joints. It gets worse over time unless the inflammation is stopped or slowed. Only in very rare cases does rheumatoid arthritis go into remission without treatment.

Arthritis medications play an essential role in controlling the progression and symptoms of rheumatoid arthritis. Starting treatment soon after diagnosis is most effective. And the best medical care combines rheumatoid arthritis medications and other approaches.

You may take rheumatoid arthritis medications alone, but they are often most effective in combination. These are the main types of RA medications:

Disease-modifying anti-rheumatic drugs (DMARDs)
Biologic response modifiers (a type of DMARD)
Glucocorticoids
Nonsteroidal anti-inflammatory medications (NSAIDs)
Analgesics (painkillers)
In the past, doctors took a conservative, stepwise approach toward treating rheumatoid arthritis. They started first with NSAIDs such as ibuprofen. Then, they progressed to more potent RA drugs for people who showed signs of joint damage.

Today, doctors know that an aggressive approach is often more effective; it will result in fewer symptoms, better function, less joint damage, and decreased disability. The goal, if possible, is to put the disease into remission.

Rheumatoid Arthritis Drugs: DMARDs

If you’ve been diagnosed with rheumatoid arthritis, your doctor may recommend that you begin treatment with one of several types of DMARDs within a few months of diagnosis. One of the most important drugs in the arsenal for treating rheumatoid arthritis, DMARDs can often slow or stop the progression of RA by interrupting the immune process that promotes inflammation. However, they may take up to six months to be fully effective.

DMARDs have greatly improved the quality of life for many people with rheumatoid arthritis. These RA drugs are often used along with NSAIDs or glucocorticoids; however, with this type of medication, you may not need other anti-inflammatories or analgesics.

Because DMARDs target the immune system, they also can weaken the immune system’s ability to fight infections. This means you must be watchful for early signs of infection. In some cases, you may also need regular blood tests to make sure the drug is not hurting blood cells or certain organs such as your liver, lungs, or kidneys.

Examples of DMARDs:

 

Name Brand Name(s) Precautions Potential Side Effects
auranofin
(oral gold) Ridaura
Limit exposure to sunlight and tell your doctor if you have had:
• Any adverse reactions to gold-containing medications
• A history of blood-cell problems
• Inflammatory bowel, kidney, or bowel disease

• Diarrhea
• Low blood counts
• Metallic taste
• Mouth ulcers

• Skin rash or itching
azathiaprine

Imuran
Tell your doctor if:
• You use allopurinol
• You have kidney or liver disease

• Fever or chills
• Loss of appetite
• Liver problems
• Low blood counts
• Nausea or vomiting
• Extreme fatigue

Rare:

Azathiaprine is associated with certain cancers, such as lymphoma.
cyclosporine

Sandimmune, Neoral
Tell your doctor if you have:
• Liver or kidney disease
• Active infection
• High blood pressure

• Headache
• High blood pressure
• Hair growth
• Kidney problems
• Loss of appetite
• Nausea

Increased risk of infection and certain cancers.
gold sodium thiomalate (injectable gold)
Myochrysine

Tell your doctor if you have:
• Lupus
• Skin rash
• Kidney disease
• Colitis

• Irritated, sore tongue
• Irritated, bleeding gums
• Metallic taste
• Skin rash or itching
• White spots on mouth or throat

Joint pain may occur for a few days after first few injections.

hydroxychloroquine sulfate Plaquenil Tell your doctor if you have vision problems; vision may be damaged with high doses or long-term use.
• Blurry vision or increased light sensitivity
• Headache
• Abdominal cramps or pain
• Loss of appetite, nausea, vomiting, or diarrhea
• Itching or rashes

leflunomide Arava
Tell your doctor if you have:
• Active infection
• Liver or kidney disease
• Cancer

Stop taking leflunomide before trying to conceive.
• Dizziness
• Hair loss
• Headache
• Heartburn
• High blood pressure
• Gastrointestinal or liver problems
• Low blood cell count
• Neuropathy
• Skin rash

methotrexate Rheumatrex, Trexall Tell your doctor if you have:
• Abnormal blood counts
• Liver or lung disease
• Alcoholism
• Active infection or hepatitis
• Abdominal pain
• Chills or fever
• Dizziness
• Hair loss
• Headache
• Light sensitivity
• Itching
• Liver problems
• Low blood counts

Rare, but serious:

Dry cough, fever, or trouble breathing, which may result from a blood disease.

Rheumatoid Arthritis Drugs: Biologic Response Modifiers

Biologic response modifiers are a type of DMARD. They target the part of the immune system response that leads to inflammation and joint damage. By doing this, they can improve your condition and help relieve symptoms.

These RA medications can’t cure rheumatoid arthritis. If the drugs are stopped, symptoms may return. But just as with other DMARDs, biologic response modifiers may slow the progression of the disease or help put it into remission. If your doctor prescribes one of these RA drugs, you will likely take it in combination with methotrexate. Biologic response modifiers are taken by injection and are expensive. Their long-term effects are unknown.

NOTE: Before taking biologics, it’s important to get appropriate vaccinations and to be tested for tuberculosis and hepatitis B and C.

 

Examples of biologic response modifiers:

Name Brand Name Precautions Potential Side Effects
abatacept Orencia
• Tell your doctor if you have a serious infection, such as pneumonia or COPD.
• Do not take live vaccines.
• Get tested for TB before starting treatment.

• Cough
• Dizziness
• Headache
• Serious infection
• Infusion reaction
adalimumab

Humira
• Tell your doctor if you have a serious infection, such as pneumonia.
• Do not take live vaccines.

Get tested for TB before starting treatment.

• Redness, pain, itching, or bruising at injection site
• Upper respiratory infection

anakinra

Kineret • Tell your doctor if you have a serious infection or a history of it.
• Do not take live vaccines. • Redness, swelling, pain, or bruising at injection site
• Low white blood cell count
• Upper respiratory infection
etanercept
Enbrel

Do not take if you have congestive heart failure, and tell your doctor if you have:
• A serious infection
• Been exposed to TB
• A serious nervous system disorder
• Do not take live vaccines.

• Redness, pain, itching, swelling, or bruising at injection site
• Headache
• Sinus infection

Rare complications:
• Lupus
• Multiple sclerosis
• Seizures

infliximab Remicade Tell your doctor if you have:
• A serious infection, especially hepatitis B
• Been exposed to TB
• A serious nervous system disorder
• Do not take live vaccines.
• Chest pain
• Hives and trouble breathing
• Changes in blood pressure
• Redness, pain, swelling, or itching at the injection site
• Sinus infection

Rare complications:
• Lupus
• Multiple sclerosis
• Seizures

rituximab Rituxan
• Tell your doctor if you have a serious infection, or heart or lung disease.
• Do not take live vaccines.

• Abdominal pain
• Chills or fever
• Headache
• Infection
• Itching

Serious side effects:
• Infusion reactions
• Tumor lysis syndrome
• Severe skin reactions

golimumab Simponi
• Tell your doctor if you have any infections or health conditions, like heart disease, MS, or diabetes.
• Get tested for TB before starting treatment.
• Do not take live vaccines.
• See your doctor right away if you develop signs of infection while taking this drug.

• Redness at the injection site
• Upper respiratory infections
• Nausea
• Abnormal liver tests

Rare complications:
• Serious infections, like TB, fungal infections, and reactivation of a previous hepatitis B infection
• Lupus
• Multiple sclerosis
certolizumab pegol Cimzia
• Tell your doctor if you have an infection or are being treated for an infection, or if you have diabetes, HIV, hepatitis B, cancer, or TB.

• Heart failure
• Nerve problems such as MS
• Allergic reactions
• Autoimmune problems like lupus
• Reactivation of hepatitis B

tocilizumab Actemra
• Tell your doctor if you have a serious infection, history of gastrointestinal perforation, or if you are pregnant or plan on becoming pregnant.
• Do not take live vaccines.

• Upper respiratory tract infection
• Inflammation of the nose or throat
• High blood pressure
• Headache
• Abnormal liver enzyme level
• Serious infections, like TB, and infections from bacteria, viruses, or fungi

tofacitinib Xeljanz • Xeljanz adds to risk of serious infections, cancers, lymphoma.
• May increase cholesterol levels and liver enzymes.
• May lower blood count.
• Upper respiratory tract infection
• Headache
• Diarrhea
• Inflammation of the nasal passage and the upper part of the throat

Rheumatoid Arthritis Drugs: Glucocorticoids

Glucocorticoids are steroids. They are strong anti-inflammatory drugs that can also block other immune responses. These rheumatoid arthritis medications help relieve symptoms and may stop or slow joint damage. You receive these RA drugs by pill, or by injection.

Because of the risk of side effects, you should only use these RA drugs for brief periods, for example, when disease flares up or until DMARDs reach their full effectiveness. If your side effects are severe, don’t stop taking the drug suddenly. Talk first with your doctor about what to do.

Examples of glucocorticoids:

 

Name Brand Name(s) Precautions Potential Side Effects
betamethasone

injectable

Celestone Tell your doctor if you have:
• Fungal infection
• History of TB
• Underactive thyroid
• Diabetes
• Stomach ulcer
• High blood pressure
• Osteoporosis • Bruising
• Cataracts
• Increased cholesterol
•Atherosclerosis
• High blood pressure
• Increased appetite or indigestion
• Mood swings or nervousness
• Muscle weakness
• Osteoporosis
• Infections
prednisone

Deltasone, Meticorten, Orasone Tell your doctor if you have:
• Fungal infection
• History of TB
• Underactive thyroid
• Diabetes
• Stomach ulcer
• High blood pressure
• Osteoporosis • Bruising
• Cataracts
• Increased cholesterol
•Atherosclerosis
• High blood pressure
• Increased appetite or indigestion
• Mood swings or nervousness
• Muscle weakness
• Osteoporosis
• Infections

Rheumatoid Arthritis Drugs: NSAIDs

NSAIDs work by blocking an enzyme that promotes inflammation. By reducing inflammation, NSAIDS help reduce swelling and pain. But they are not effective in reducing joint damage. These drugs alone are not effective in treating the disease. They should be taken in combination with other rheumatoid arthritis medications.

As with glucocorticoids, you should use them for brief periods — they can cause severe digestive tract problems. Which type, if any, your doctor prescribes may depend upon your medical history. If you have a history of liver, kidney, heart problems or stomach ulcers, it’s best to not take these drugs. Ask your doctor whether any new NSAIDS producing fewer side effects are available.

Examples of NSAIDs:

Name Brand Name(s) Precautions Potential Side Effects
celecoxib Celebrex • Tell your doctor if you have had a heart attack, stroke, angina, blood clot, or high blood pressure or if you have sensitivity to NSAIDS or sulfa drugs.
• Do not take with other NSAIDS.
• Do not take late in pregnancy. • Indigestion, diarrhea, and stomach pain
• Serious skin reactions
diclofenac sodium

Voltaren
Tell your doctor if you:
• Drink alcohol
• Use blood thinners
• Take ACE inhibitors, lithium, warfarin, or furosemide
• Have sensitivity to aspirin; kidney, liver, or heart disease; asthma; high blood pressure; ulcers
• Do not take with other NSAIDs.

• Abdominal cramps, diarrhea
• Dizziness or drowsiness
• Heartburn, indigestion, nausea, vomiting, ulcer, or bleeding
• Increased risk of blood clots, heart attacks, and stroke

Greater risk of complications for people with cardiovascular disease
ibuprofen Motrin, Advil
Tell your doctor if you:
• Drink alcohol
• Use blood thinners
• Take ACE inhibitors, lithium, warfarin, or furosemide
• Have sensitivity to aspirin; kidney, liver, or heart disease; asthma; high blood pressure; ulcers
• Do not take with other NSAIDS.

• Abdominal cramps, diarrhea
• Dizziness or drowsiness
• Heartburn, indigestion, nausea, vomiting, ulcer, or bleeding
• Increased risk of blood clots, heart attacks, and stroke

Greater risk of complications for people with cardiovascular disease

Rheumatoid Arthritis Drugs: Analgesics

Analgesics reduce pain but they do not reduce swelling or joint damage.

There are a variety of over-the-counter and prescription analgesics. Narcotics are the most powerful type of analgesic. Use these carefully and be sure to let your doctor know if you have any history of alcoholism or drug abuse.

Examples of analgesics:

Name Brand Name(s) Precautions Potential Side Effects
acetaminophen Tylenol, Faverall, Tempra • Tell your doctor if you have 3 or more drinks of alcohol daily.
• Avoid taking more than one product with acetaminophen.
Side effects uncommon if taken as directed.

tramadol

Ultram
• Tell your doctor if you use central nervous system depressants, tranquilizers, sleeping medications, muscle relaxants, or narcotic pain medications or if you have a history of drug or alcohol abuse.
• Do not stop suddenly or increase the dose on your own.

• Do not drive or use heavy machinery until you know how your body reacts to the drug. • Constipation
• Diarrhea
• Drowsiness
• Increased sweating
• Loss of appetite
• Nausea
oxycodone OxyContin, Roxicodone
Tell your doctor if you use central nervous system depressants, tranquilizers, sleeping medications, muscle relaxants or narcotic pain medications or if you have a history of drug or alcohol abuse.
• Never chew or cut tablets; a high dose can be fatal if released rapidly.

• Constipation
• Dizziness
• Drowsiness
• Dry mouth
• Headache
• Increased sweating
• Itchy skin
• Nausea or vomiting
• Shortness of breath

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