There are numerous drugs available for the treatment of rheumatoid arthritis (RA). Most people take a combination of drugs to manage symptoms and slow or stop joint damage.
Many RA drugs have the potential for severe side effects. In addition to the possibility of direct organ damage, some medications interfere with the function of the immune system. According to the Centers for Disease Control and Prevention (CDC), this makes people taking them more susceptible to infection. For this reason, patients who take these drugs require careful monitoring. You may need to see your rheumatologist for regular physical examinations and blood tests.
NSAIDs are a large class of drugs. They can reduce both pain and inflammation. Many NSAIDs are available over-the-counter (OTC) at low doses. Higher doses are available by prescription. NSAIDs commonly used for RA include:
- celecoxib (Celebrex)
- ibuprofen (Advil, Motrin)
- ketoprofen (Orudis, Oruvail)
- naproxen (Aleve)
NSAIDs should not be taken more often than prescribed. They can cause a number of side effects, including:
- ringing in the ears
- heart problems
- kidney damage
- liver damage
According to Mayo Clinic, corticosteroids are very effective at reducing inflammation. Unfortunately, they can have serious side effects, including:
- bone thinning (osteoporosis)
- increased blood pressure
- increased risk of infection
For this reason, they are generally only used for short periods. For example, they may be used during flare-ups if symptoms don’t respond to NSAIDs or other drugs. They can also be used to reduce symptoms when starting a different class of drug. Corticosteroids used for RA include:
- methylprednisolone (Medrol, Depo-Medrol)
- triamcinolone (Aristospan)
According to the Arthritis Foundation, if you are diagnosed, you will most likely be started on a DMARD immediately. NSAIDs and steroids can only relieve symptoms, by decreasing inflammation and reducing pain. DMARDs have the ability to actually slow the progress of RA. Taking them early in the disease process may prevent permanent damage to joints.
DMARDs can take up to several months to begin working. They are often prescribed alongside NSAIDs or corticosteroids, which reduce symptoms until the DMARDs kick in. DMARDs may be prescribed alone or in combination. This class of drugs includes:
- 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)
DMARD side effects vary depending upon the drug. Some DMARDs carry risks including:
- kidney damage
- liver damage
- bone marrow suppression
- lung damage
If you're taking one of these drugs, your doctor will monitor you closely.
Inflammation in the body is a complicated process. It involves many chemical steps. According to the Arthritis Foundation, biologic agents interrupt this process at various points. They reduce inflammation and slow or stop the progress of RA.
Biologic agents are most often prescribed with a DMARD, usually methotrexate. 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)
These drugs can have a variety of different side effects, which will be explained to you by your rheumatologist.