Rheumatoid arthritis (RA) is the second most common type of arthritis, affecting about 1.5 million Americans. It’s an inflammatory disease that’s caused by an autoimmune condition. The disease 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. This helps prevent joint damage. Read on to learn about the many treatment options for RA.
DMARDs and biologics
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 that 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)
- minocycline (Minocin)
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 your risk of serious infections.
The most common biologics include:
Janus associated kinase inhibitors
Your doctor may prescribe these drugs if DMARDs or biologics don’t work for you. These medications affect genes and the activity of immune cells in the body. They help prevent inflammation and stop damage to joints and tissues.
Janus associated kinase inhibitors include:
- tofacitinib (Xeljanz, Xeljanz XR)
Baricitinib is a new drug that’s being tested. Studies suggest that it works for people who don’t have success with DMARDs.
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
Acetaminophen is available over the counter (OTC) without a prescription from your doctor. 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. This means it doesn’t work very well to treat RA.
This drug carries the risk of serious liver problems, including liver failure. You should only take one drug that contains acetaminophen at a time.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
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 be fatal (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, you should not 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 seniors.
Ibuprofen is available in prescription strengths as well. In prescription versions, the dosage is higher. Ibuprofen may also be combined with another type of pain drug called opioids. Examples of these prescription combination drugs include:
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 sodium (Anaprox)
- naproxen (Naprosyn)
- 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)
Diclofenac/misoprostol (Arthrotec) 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 can relieve mild pain caused by RA. You rub this cream on painful areas on 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 that you may be less likely to have side effects.
Diclofenac sodium topical solution (Pennsaid 2%)
Diclofenac sodium (Pennsaid 2%) is a topical solution used for knee pain. You rub it on your knee to relieve the pain.
Opioid pain drugs
Opioids are the strongest pain drugs on the market. They’re only available as prescriptions drugs. They come in oral and injectable forms. Opioids are only used in RA treatment for people with severe RA who are in intense pain. These drugs can be habit-forming. If your doctor gives you an opioid drug, they’ll watch 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 the disease down or prevent inflammation.
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:
These drugs fight off 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 gives you one of these drugs, they’ll watch you closely during treatment.
These drugs come in oral and injectable forms. They include:
- cyclophosphamide (Cytoxan)
- cyclosporine (Gengraf, Neoral, Sandimmune)
- azathioprine (Azasan, Imuran)
- hydroxychloroquine (Plaquenil)
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.