Rheumatoid arthritis is a relatively common disorder affecting 1.3 million Americans. It usually begins between age 20 and 50, and women are affected three times as frequently as men.
Rheumatoid arthritis (RA) is characterized by inflammation and pain in the hands -- especially in the joints of the fingers, as well as in the wrists, knees, ankles, elbows, shoulders, and feet. RA can affect almost any joint in the body, except the lower back. The duration and intensity of pain vary from person to...
There are many effective pain medications your doctor could choose from. Unlike DMARDs (disease-modifying antirheumatic drugs), these medications don't slow down the joint damage that rheumatoid arthritis can cause. However, they do make living with rheumatoid arthritis easier.
Here's what you should know about some of the more common pain medicationss and anti-inflammatories prescribed for rheumatoid arthritis.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs are the cornerstone of pain management for rheumatoid arthritis. They are effective in managing pain, swelling, and stiffness. NSAIDs work by stopping the production of some of the chemicals that cause pain (prostaglandins). They are classified as "selective" versus "non-selective," based on how they work.
Examples of non-selective NSAIDs are:
Diclofenac (Voltaren, Cataflam)
Ibuprofen (Motrin, Advil)
Naproxen (Aleve, Naprosyn)
The main drawback of NSAIDs is their potential to cause ulcers or bleeding in the stomach or intestines. Taking a proton-pump inhibitor -- a drug that reduces the production of acid in the stomach -- can reduce this risk. NSAIDs also often cause general stomach upset or discomfort.
NSAIDs can also cause problems if you already have kidney failure or heart failure. A doctor should follow closely if you have these conditions and are taking NSAIDs.
Selective NSAIDs (Celebrex)
These drugs are NSAIDs but have a significantly lower risk of ulcers and stomach or intestinal bleeding. They relieve pain as well as non-selective NSAIDs.
In 2004 and 2005, two selective NSAIDs, Vioxx and Bextra, were taken off the market by their manufacturers. This was done because in some studies, people seemed to develop heart attacks and strokes slightly more often when taking these drugs. Celebrex at doses used to treat arthritis (200 milligrams per day) did not have this association and is still available.
Selective NSAIDs are probably best used by a person with a high risk for gastrointestinal bleeding.
Acetaminophen is a well-known over-the-counter drug. Its main advantage is its safety. When taken as directed, it has few side effects in most people. One exception is people with liver disease, who can take acetaminophen only under close supervision by a doctor.
Corticosteroids are powerful drugs that can stop inflammation in its tracks. These are different from anabolic steroids like testosterone, which cause muscle growth. Corticosteroids act throughout the body with various widespread effects. In rheumatoid arthritis, the benefit of corticosteroids is their suppression of the overactive immune system, which reduces symptoms and disease activity.
Because corticosteroids act everywhere, not just on the immune system, they are ideally used for short bursts to control flares. This helps avoid their side effects. If you have severe rheumatoid arthritis, you may need to take corticosteroids for long periods. Your doctor will help watch out for potential problems of long-term steroid use. These include increased susceptibility to infection, increased blood sugar (diabetes), or bone thinning.
Corticosteroids can also sometimes be injected directly into joints affected by rheumatoid arthritis. This is a great way to get the benefits of the drug without as many of the side effects.
SOURCES: American College of Rheumatology Ad Hoc Committee on Clinical Guidelines. Arthritis and Rheumatism, May 1996; vol 39: p 713. Baum, C., Arthritis and Rheumatism, 1985; vol 28: pp 686. Capell, H., Annals of Rheumatic Disease, 2004; vol 63: p 797. eMedicine.com: "Rheumatoid arthritis." Hooper, L., BMJ, 2004; vol 329: p 948. Kirwan, J., New England Journal of Medicine, 1995; vol 333: p 142. Saag, K., American Journal of Medicine, 1994; vol 96: p 115.