Rheumatoid Arthritis Medications
Medications for rheumatoid arthritis (RA) are varied in both type and action to control the symptoms and the progress of the disease. In the past, the main goal of treatment was control of symptoms but this had a serious drawback. While the patient might feel better and have better function, the underlying disease might still be progressing. Modern therapy is more aggressive with the treatment goal of complete remission.Current therapy is so effective that about 90% of RA patients avoid the debilitating and disabling form of the disease. Early treatment and diagnosis is important because most damage to joints and other tissues is not reversible. Of course, this means for about one in ten RA patients this is still a crippling illness, so the work to find better drugs and combinations and hopefully an actual cure goes on.
Drugs to treat RA fall into some general classes. Some drugs are called analgesics, and these relieve pain but many have no effect on the actual disease. These include acetaminophen (Tylenol) and narcotic drugs as well as the other prescription medication called tramadol (Ultram). While these may be necessary to control pain while the underlying RA is being brought into control, they cannot stop the progress or the damage of the condition.
Steroidal medications such as prednisone are also given to control inflammation and also to decrease pain and symptoms. Like all steroids, they carry risks such as fluid retention and increased incidence of diabetes, but can be an important part of aggressive therapy.
Another class of medication is the NSAID, or the non-steroidal anti-inflammatory drug. This class contains both prescription and over the counter medications. Ordinary aspirin is one such drug and may be part of the treatment as well as being analgesic to relieve pain. Other over the counter NSAIDs include ibuprofen, naproxen, and ketoprofen, all sold under various brand names. Prescription NSAIDs include piroxicam (Feldene) and diclofenac (Voltaren or Cataflam). All of these are called COX-1 and COX-2 inhibitors and all can cause stomach distress, bleeding, and even ulcers.
Another class of NSAIDs is called the COX-2 inhibitor class, but there have been problems with these stomach-protective drugs. Some have been associated with serious health risks and have been removed from the market. The only one current available in the United States is celecoxib or Celebrex.
Other medications for RA are called disease-modifying anti-rheumatic drugs or DMARDs. These drugs also decrease inflammation and inhibit the autoimmune response that causes damage in RA. A secondary class of these drugs is called the biologic response modifying drug group, and these are also sometimes called slow acting drugs since they take some time to be effective. Most of the latter are given by injection or by intravenous (IV) infusions, usually once or twice weekly or less often.
The DMARDs include such drugs as Plaquenil, Imuran, cyclosporine, gold salts, sulfasalazine, leflunomide, penicillamine, and one of the most common and effective drugs, methotrexate (Rheumatrex or Folex). These are mostly given orally, and while all have side effects, most are pretty well tolerated and do actually stop the progress of rheumatoid arthritis and prevent further damage.
The biologic response modifiers include etanercept or Enbrel, infliximab or Remicade, adalimumab or Humira, anakinra or Kineret, and abatacept or Orencia. Etanercept, infliximab and adalimumab are all tumor necrosis factor inhibitors while the others modify immune response in different ways. Some inhibit t-cells and others interfere with interleukins to calm down the immune system. Since damage in RA occurs because the immune system is attacking its own tissues, the effect of these drugs is very helpful.
Choosing which medication or medications a patient with RA will take is a decision that needs to be made by an expert in rheumatology and in RA in particular. Most patients will need more than a single agent for good disease control and hopefully a remission. Assessing how well medication is working is done through blood tests, imaging studies as well as by clinical response. Current medications mean most people with RA will do well and lead mostly normal lives.
Resources
EMedicine guide to understanding RA medications:
RA drug guide from Web MD
Comprehensive About.com arthritis treatment information:
Information on RA medications from Johns Hopkins University: