Drugs

Most rheumatoid arthritis (RA) patients take a combination of multiple drugs both to manage symptoms and slow or stop joint damage. Many RA drugs have the potential for severe side effects, and some reduce immune-system function, which makes people taking them more susceptible to infection. For this reason, your rheumatologist will closely monitor you through exams and blood tests while you're taking these medications.

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

NSAIDs are a large class of drugs that reduce both pain and inflammation.  Many NSAIDs are available over the counter at low doses and at higher doses by prescription. NSAIDs can cause gastrointestinal side effects, such as nausea, diarrhea, and stomach ulcers, and in rare cases can cause kidney or liver damage. NSAIDs commonly used for RA include:

  • aspirin
  • celecoxib (Celebrex)
  • ibuprofen (Advil, Motrin)
  • ketoprofen (Orudis, Oruvail)
  • naproxen (Aleve)

Corticosteroids

Corticosteroids are very effective at reducing inflammation. Unfortunately, when used for prolonged periods, they have serious side effects, including diabetes, osteoporosis, increased blood pressure, cataracts, and an increased risk of infection. For this reason, they are generally used for short periods during flare-ups, if symptoms do not respond to NSAIDs or other drugs, or to reduce symptoms when starting a different class of drug. Corticosteroids used for RA include:

  • dexamethasone
  • methylprednisolone (Medrol, Depo-Medrol)
  • prednisolone
  • prednisone
  • triamcinolone (Aristospan)

Disease-Modifying Anti-Rheumatic Drugs (DMARDs)

DMARDs are the most common drugs used for rheumatoid arthritis. If you are diagnosed, you will most likely be started on a DMARD immediately. Unlike NSAIDs and steroids—which only relieve symptoms—DMARDs have the ability to actually slow the progress of RA and prevent permanent damage to joints. DMARDs can take a long time to begin working—anywhere from a few weeks to several months—so they are often prescribed alongside NSAIDs or corticosteroids to reduce symptoms until they kick in. Side effects vary depending upon the drug, but some DMARDs carry the risks of kidney or liver damage. If you're taking one of these, your doctor will monitor you closely to make sure you are not affected. DMARDs may be prescribed alone or in combination, and the class includes a variety of drugs:

  • auranofin (Ridaura)
  • azathioprine (Imuran, Azasan)
  • chlorambucil (Leukeran)
  • cyclosporine (Neoral, Sandimmune, Gengraf)
  • cyclophosphamide (Cytoxan)
  • gold sodium thiomalate (Myochrisine, Aurolate)
  • hydroxychloroquine (Plaquenil)
  • leflunomide (Arava)
  • methotrexate (Rhuematrex, Trexall, Folex)
  • minocycline (Dynacin, Minocin, Vectrin)
  • sulfasalazine (Azulfidine)

Biologic agents

Inflammation in the body is a complicated immune-system process that involves many chemical steps. Biologic agents interrupt this process at various points, thus reducing inflammation and slowing or stopping the progress of RA. Biologic agents are most often prescribed with a DMARD (usually methotrexate), as this makes them more effective. Biologic agents used for RA include:

  • abatacept (Orencia)
  • adalimumab (Humira)
  • anakinra (Kineret)
  • certolizumab (Cimzia)
  • etanercept (Enbrel)
  • golimumab (Simponi)
  • infliximab (Remicade)
  • rituximab (Rituxan)