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Rheumatoid Arthritis: Finding the Right Medication for You

New drugs offer more options to short-circuit rheumatoid arthritis.
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Pros and Cons of Medications Used to Treat Rheumatoid Arthritis continued...

Analgesics (Painkillers)

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

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)

Disease-Modifying Drugs

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.

There is a downside to many DMARDs: They can suppress the immune system, so there is greater susceptibility for infection while taking these drugs. It's important to watch for signs of infection like fever and chills.

DMARDs include:

  • Azathioprine (Imuran)
  • Cyclosporine (Neoral and Sandimmune)
  • Cyclophosphamide (Cytoxan and Neosar)
  • Gold salts (Ridaura)
  • Hydroxychloroquine (Plaquenil)
  • Leflunomide (Arava)
  • Methotrexate (Rheumatrex and Folex)
  • Minocycline (Dynacin and Minocin)
  • Penicillamine (Cuprimine and Depen)
  • Sulfasalazine (Azulfidine)

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