Rheumatoid arthritis (RA) is one of the most common forms of arthritis.
RA is an inflammatory and autoimmune disease. It occurs when your body attacks its own healthy joint tissues. This results in redness, inflammation, and pain.
The main goal of RA drugs is to block inflammation to help prevent joint damage.
Read on to learn about the many treatment options for RA.
Disease-modifying antirheumatic drugs (DMARDs) are used to decrease inflammation. Unlike other medications that temporarily ease pain and inflammation, DMARDs can slow the progression of RA. This means you may have fewer symptoms and less damage over time.
The most common DMARDs used to treat RA include:
- hydroxychloroquine (Plaquenil)
- leflunomide (Arava)
- methotrexate (Trexall)
- sulfasalazine (Azulfidine)
Biologics are injectable drugs. They work by blocking specific inflammatory pathways made by immune cells. This reduces inflammation caused by RA. Doctors prescribe biologics when DMARDs alone aren’t enough to treat RA symptoms.
Biologics aren’t recommended for people with compromised immune systems or an infection. This is because they can raise the risk of serious infections.
The most common biologics include:
- abatacept (Orencia)
- adalimumab (Humira)
- certolizumab pegol (Cimzia)
- etanercept (Enbrel)
- golimumab (Simponi)
- infliximab (Remicade)
- rituximab (Rituxan)
- tocilizumab (Actemra)
Your doctor may prescribe JAK inhibitors if DMARDs or biologics aren’t treating your RA as well. These medications affect genes and the activity of immune cells in the body. They help prevent inflammation and stop damage to joints and tissues.
JAK inhibitors include:
- baricitinib (Olumiant)
- tofacitinib (Xeljanz, Xeljanz XR)
- upadacitinib (Rinvoq)
Before starting a JAK inhibitor, ask your doctor to ensure you’re up to date on all immunizations, including prophylactic zoster vaccinations (shingles vaccine).
The more common side effects of these drugs include:
- upper respiratory infections, like sinus infections or the common cold
- congested nose
- runny nose
- sore throat
- cystitis (urinary bladder infection)
Acetaminophen is available over the counter (OTC) without a prescription. It comes as an oral drug and a rectal suppository.
Other drugs are much more effective at reducing inflammation and treating pain in RA. This is because acetaminophen can treat mild to moderate pain, but it doesn’t have any anti-inflammatory activity. So, it doesn’t work very well to treat RA.
This drug carries the risk of serious liver problems, including liver failure. Only take one drug that contains acetaminophen at a time.
NSAIDs are among the most commonly used RA drugs. Unlike other pain relievers, NSAIDs seem to be more effective in treating symptoms of RA. This is because they prevent inflammation.
Some people use OTC NSAIDs. However, stronger NSAIDs are available with a prescription.
Side effects of NSAIDs include:
- stomach irritation
- erosion or burning a hole through your stomach or intestines
- stomach bleeding
- kidney damage
In rare cases, these side effects can cause death. If you use NSAIDs for a long time, your doctor will monitor your kidney function. This is especially likely if you already have kidney disease.
Ibuprofen (Advil, Motrin IB, Nuprin)
OTC ibuprofen is the most common NSAID. Unless instructed by your doctor, don’t use ibuprofen for more than several days at a time. Taking this drug for too long can cause stomach bleeding. This risk is greater in older adults.
Ibuprofen is available in prescription strengths as well. In prescription versions, the dosage is higher. Ibuprofen may also be combined with opioids, another type of pain drug. Examples of these prescription combination drugs include:
- ibuprofen/hydrocodone (Vicoprofen)
- ibuprofen/oxycodone (Combunox)
Naproxen sodium (Aleve)
Naproxen sodium is an OTC NSAID. It’s often used as an alternative to ibuprofen. This is because it causes slightly fewer side effects. Prescription versions of this drug offer stronger dosages.
Aspirin (Bayer, Bufferin, St. Joseph)
Aspirin is an oral pain reliever. It’s used to treat mild pain, fever, and inflammation. It can also be used to prevent heart attack and stroke.
When OTC NSAIDs don’t relieve your RA symptoms, your doctor may prescribe a prescription NSAID. These are oral drugs. The most common options include:
- celecoxib (Celebrex)
- ibuprofen (prescription strength)
- nabumetone (Relafen)
- naproxen (Naprosyn)
- naproxen sodium (Anaprox)
- piroxicam (Feldene)
Other NSAIDs include:
- diclofenac (Voltaren, Diclofenac Sodium XR, Cataflam, Cambia)
- indomethacin (Indocin)
- ketoprofen (Orudis, Ketoprofen ER, Oruvail, Actron)
- etodolac (Lodine)
- fenoprofen (Nalfon)
- ketorolac (Toradol)
- mefenamic acid (Ponstel)
- meloxicam (Mobic)
- oxaprozin (Daypro)
- sulindac (Clinoril)
- salsalate (Disalcid, Amigesic, Marthritic, Salflex, Mono-Gesic, Anaflex, Salsitab)
- tolmetin (Tolectin)
This is an oral drug that combines the NSAID diclofenac with misoprostol. NSAIDs can cause stomach ulcers. This drug helps prevent them.
Topical capsaicin (Capsin, Zostrix, Dolorac)
Capsaicin topical OTC cream may relieve mild pain caused by RA. You rub this cream on painful areas of your body.
Diclofenac sodium topical gel (Voltaren 1%)
Voltaren gel 1% is an NSAID for topical use. This means you rub it on your skin. It’s approved to treat joint pain, including in your hands and knees.
This drug causes similar side effects to oral NSAIDs. However, only about 4 percent of this drug is absorbed into your body. This means you may be less likely to have side effects.
Diclofenac sodium topical solution (Pennsaid 2%)
Diclofenac sodium (Pennsaid 2%) and 1.5% are topical solutions used for knee pain. You rub it on your knee to relieve pain.
Opioids are the strongest pain drugs on the market. They’re only available as prescriptions.
Opioids come in oral and injectable forms. They’re only used for severe RA that is causing intense pain since opioids can lead to dependence. If your doctor prescribes an opioid, they’ll monitor you closely.
People with RA who take opioids should also use other treatments. This is because opioids only change the way you experience pain. They don’t slow down the disease or prevent inflammation.
- hydrocodone (Vicodin)
- meperidine (Demerol)
- oxycodone (OxyContin)
- oxymorphone (Opana, Opana ER)
- tramadol (Ultram)
Corticosteroids are also called steroids. They come as oral and injectable drugs. These drugs can help reduce inflammation in RA. They may also help reduce the pain and damage caused by inflammation. These drugs aren’t recommended for long-term use.
Side effects can include:
- high blood sugar
- stomach ulcers
- high blood pressure
- emotional side effects, such as irritability and excitability
- cataracts, or clouding of the lens in your eye
Steroids used for RA include:
- dexamethasone (Dexpak Taperpak, Decadron, Hexadrol)
- hydrocortisone (Cortef, A-Hydrocort)
- methylprednisolone (Medrol, Methacort, Depopred, Predacorten)
- prednisone (Deltasone, Sterapred, Liquid Pred)
These drugs fight the damage caused by autoimmune diseases such as RA. However, these drugs can also make you more prone to illness and infection. If your doctor prescribes one of these drugs, they’ll monitor you closely during treatment.
These drugs come in oral and injectable forms, like cyclophosphamide (Cytoxan).
Work with your doctor to find the RA treatment that works best for you. With so many options available, you and your doctor are likely to find one that eases your RA symptoms and improves your quality of life.