Rheumatoid Arthritis: Finding the Right Medication for You
New drugs offer more options to short-circuit rheumatoid arthritis.
Pros and Cons of Medications Used to Treat Rheumatoid Arthritis
Here are brief descriptions of the various medications used to treat rheumatoid arthritis.
These drugs are used by nearly everyone with some form of arthritis. There are several options available over the counter and by prescription -- and all work to relieve joint swelling, stiffness, and pain. However, they do not stop the disease from getting worse.
Traditional nonsteroidal anti-inflammatory drugs (NSAIDs) like Motrin and Aleve can be hard on the stomach. Cox-2 inhibitors like celecoxib (Celebrex) are newer NSAIDs that are safer for the stomach, yet just as effective in relieving pain and inflammation.
All prescription NSAIDs, including Celebrex, carry an FDA warning about the risk of heart attacks, strokes, and potentially life-threatening stomach bleeding. But these drugs are a very effective treatment for rheumatoid arthritis. Patients and their doctors need to weigh the benefits of these drugs with the risks. Controlling risk factors such as cholesterol and blood pressure can help lower the heart and stroke risk.
Analgesics are solely for pain relief; they do not reduce inflammation, but may help control pain. Patients often take nonprescription acetaminophen (like Tylenol). There are also prescription pain relievers, some of which are narcotics. Narcotics are used for severe pain not relieved with other medications. A note of caution: It is possible to develop dependency on narcotic drugs, and they can cause constipation, urinary problems, and sedation.
Prescription narcotic painkillers include:
- Acetaminophen with codeine (such as Tylenol with codeine).
- Acetaminophen with hydrocodone (such as Vicodin).
- Propoxyphene (Darvon) with acetaminophen (Darvocet).
Tramadol (Ultram) and tramadol with acetaminophen (Ultracet) are not narcotics but still carry a risk of dependency.
Steroids (short for corticosteroids) are powerful anti-inflammatory drugs. They work by reducing the activity of the immune system -- specifically, the function of white blood cells -- which reduces inflammation that can damage joints. Steroid pills are often used temporarily to treat severe flare-ups.
Potentially severe side effects may occur with long-term use (months to weeks) of steroid pills; the side effects include cataracts, bruising, high cholesterol, high blood sugar, and high blood pressure. To help avoid these problems, doctors prescribe the lowest dose possible. They can also inject steroids into the affected joint, which greatly lowers the chance of these side effects.
Commonly used steroids include:
- Cortisone (Cortone)
- Prednisone (Deltasone)
In the early stages of the disease, these drugs can help prevent the joint damage that inflammation causes. The drugs are called disease-modifying antirheumatic drugs (DMARDs) -- and they work by interfering with immune system activity that triggers damaging inflammation.
Because the drugs can prevent joint damage, one or more DMARDs are prescribed very early in treatment. DMARDs take weeks to really start working so steroids or painkillers are sometimes used until they kick in.