Rheumatoid Arthritis Drug Guide

Rheumatoid arthritis (RA) is a progressive inflammatory disease that affects the joints. It gets worse over time unless the inflammation is stopped or slowed. Only in very rare cases does rheumatoid arthritis go into remission without treatment.

Arthritis medications play an essential role in controlling the progression and symptoms of rheumatoid arthritis. Starting treatment soon after diagnosis is most effective. And the best medical care combines rheumatoid arthritis medications and other approaches.

You may take rheumatoid arthritis medications alone, but they are often most effective in combination. These are the main types of RA medications:

  • Disease-modifying anti-rheumatic drugs (DMARDs)
  • Biologic response modifiers (a type of DMARD)
  • Glucocorticoids
  • Nonsteroidal anti-inflammatory medications (NSAIDs)
  • Analgesics (painkillers)

In the past, doctors took a conservative, stepwise approach toward treating rheumatoid arthritis. They started first with NSAIDs such as ibuprofen. Then, they progressed to more potent RA drugs for people who showed signs of joint damage.

Today, doctors know that an aggressive approach is often more effective; it will result in fewer symptoms, better function, less joint damage, and decreased disability. The goal, if possible, is to put the disease into remission.

Rheumatoid Arthritis Drugs: DMARDs

If you've been diagnosed with rheumatoid arthritis, your doctor may recommend that you begin treatment with one of several types of DMARDs within a few months of diagnosis. One of the most important drugs in the arsenal for treating rheumatoid arthritis, DMARDs can often slow or stop the progression of RA by interrupting the immune process that promotes inflammation. However, they may take up to six months to be fully effective.

DMARDs have greatly improved the quality of life for many people with rheumatoid arthritis. These RA drugs are often used along with NSAIDs or glucocorticoids; however, with this type of medication, you may not need other anti-inflammatories or analgesics.

Because DMARDs target the immune system, they also can weaken the immune system's ability to fight infections. This means you must be watchful for early signs of infection. In some cases, you may also need regular blood tests to make sure the drug is not hurting blood cells or certain organs such as your liver, lungs, or kidneys.

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Examples of DMARDs:

 

Name Brand Name(s) Precautions Potential Side Effects
hydroxychloroquine sulfate Plaquenil Tell your doctor if you have vision problems; vision may be damaged with high doses or long-term use.

• Blurry vision or increased light sensitivity
Headache
• Abdominal cramps or pain
• Loss of appetite, nausea, vomiting, or diarrhea
Itching or rashes

leflunomide Arava

Tell your doctor if you have:
• Active infection
• Liver or kidney disease
• Cancer

Stop taking leflunomide before trying to conceive.

Dizziness
Hair loss
Headache
Heartburn
High blood pressure
• Gastrointestinal or liver problems
• Low blood cell count
Neuropathy
Skin rash

methotrexate Rheumatrex, Trexall

Tell your doctor if you have:
• Abnormal blood counts
• Liver or lung diseaseAlcoholism• Active infection or hepatitis• Active plans to conceive

 

 

 

Abdominal pain
• Chills or fever
• Dizziness
Hair loss
Headache
• Light sensitivity
Itching
• Liver problems
• Low blood counts


Rare, but serious:

Dry cough, fever, or trouble breathing, which may result from lung inflammation
tofacitinib Xeljanz • Xeljanz adds to risk of serious infections, cancers, lymphoma.
• May increase cholesterol levels and liver enzymes.
• May lower blood count.
• Upper respiratory tract infection
Headache
• Diarrhea
• Inflammation of the nasal passage and the upper part of the throat

 

Rheumatoid Arthritis Drugs: Biologic Response Modifiers

Biologic response modifiers are a type of DMARD. They target the part of the immune system response that leads to inflammation and joint damage. By doing this, they can improve your condition and help relieve symptoms.

These RA medications can't cure rheumatoid arthritis. If the drugs are stopped, symptoms may return. But just as with other DMARDs, biologic response modifiers may slow the progression of the disease or help put it into remission. If your doctor prescribes one of these RA drugs, you will likely take it in combination with methotrexate. Biologic response modifiers are taken by injection and/or by IV and are expensive. Their long-term effects are unknown.

NOTE: Before taking biologics, it's important to get appropriate vaccinations and to be tested for tuberculosis and hepatitis B and C.

Examples of biologic response modifiers:
 

Name Brand Name Precautions Potential Side Effects
abatacept Orencia • Tell your doctor if you have a serious infection, such as pneumonia or COPD.
• Do not take live vaccines.
• Get tested for TB and hepatitis before starting treatment.
• Cough
• Dizziness
• Headache
• Serious infection
• Infusion reaction
• Serious infections, like TB, and infections from bacteria, viruses, or fungi
adalimumab Humira

• Tell your doctor if you have a serious infection, such as pneumonia.
• Do not take live vaccines.

Get tested for TB and hepatitis before starting treatment.

• Redness, pain, itching, or bruising at injection site
• Upper respiratory infection
• Serious infections, like TB, and infections from bacteria, viruses, or fungi
adalimumab-atto Amjevita, a biosimilar to Humira

Tell your doctor if you have congestive heart failure.

Your doctor should test you for tuberculosis and hepatitis.

• Reactions at the injection site
• Upper respiratory infections
• Rash
• Headaches
• Serious infections, such as tuberculosis and sepsis
• Higher risk for lymphoma and other cancers
anakinra Kineret • Tell your doctor if you have a serious infection or a history of it.
• Do not take live vaccines.

• Redness, swelling, pain, or bruising at injection site
• Low white blood cell count
• Upper respiratory infection

• Serious infections, like TB, and infections from bacteria, viruses, or fungi

etanercept Enbrel Do not take if you have congestive heart failure, and tell your doctor if you have:
• A serious infection
• Been exposed to TB or have hepatitis
• A serious nervous system disorder
• Do not take live vaccines.
 

• Redness, pain, itching, swelling, or bruising at injection site
• Headache
• Sinus infection

Rare complications:
• Lupus
• Multiple sclerosis
• Seizures

• Serious infections, like TB, and infections from bacteria, viruses, or fungi

etanercept-szzs Ereizi, a biosimilar to Enbrel

Do not take if you have congestive heart failure, and tell your doctor if you have:
• diabetes, HIV, or a weakened immune system

• have or have had hepatitis B
• Been exposed to TB
• A serious nervous system disorder
• Do not take live vaccines.

.
 

Redness, pain, itching, swelling, or bruising at injection site
• Headache
Rashes

• Nausea

• Fatigue

• Abdominal Pain

Rare complications:
• Increased risk of malignancy

Neurological events

• Serious infections, like TB, and infections from bacteria or fungi

 

rituximab Rituxan • Tell your doctor if you have a serious infection, or heart or lung disease.
• Do not take live vaccines.

• Abdominal pain
• Chills or fever
• Headache
• Infection
• Itching

Serious side effects:
• Infusion reactions
• Tumor lysis syndrome
• Severe skin reactions

• Serious infections, like TB, and infections from bacteria, viruses, or fungi

infliximab-dyyb Inflectra, a biosimilar to Remicade

• Do not take this medicine if you have moderate to severe heart failure.

• Tell your doctor if you have had tuberculosis or hepatitis.

• Diarrhea
• Headache
• Fatigue
• Nausea
• Rash at site of infusion
• Upper respiratory infections
• Urinary tract infections
• Tuberculosis
• Sepsis
• Fungal infections
golimumab

Simponi

Simponi Aria

• Tell your doctor if you have any infections or health conditions, like heart disease, MS, or diabetes• Get tested for TB before starting treatment.
• Do not take live vaccines.
• See your doctor right away if you develop signs of infection while taking this drug.

• Redness at the injection site
• Upper respiratory infections
• Nausea
• Abnormal liver tests

Rare complications:
• Serious infections, like TB, fungal infections, and reactivation of a previous hepatitis B infection
• Lupus
• Multiple sclerosis

• Serious infections, like TB, and infections from bacteria, viruses, or fungi

certolizumab pegol Cimzia • Tell your doctor if you have an infection or are being treated for an infection, or if you have diabetes, HIV, hepatitis B, cancer, or TB. • Nerve problems such as MS
• Allergic reactions
• Autoimmune problems like lupus
• Reactivation of hepatitis B
• Serious infections, like TB, and infections from bacteria, viruses, or fungi
tocilizumab Actemra • Tell your doctor if you have a serious infection, history of gastrointestinal perforation, or if you are pregnant or plan on becoming pregnant.
• Do not take live vaccines.
• Upper respiratory tract infection
• Inflammation of the nose or throat
• High blood pressure
• Headache
• Abnormal liver enzyme level
• Serious infections, like TB, and infections from bacteria, viruses, or fungi
sarilumab Kevzara

• Tell your doctor if you have had TB, if your immune system is weakened by deconditions such as diabetes, hepatitis or HIV

• if you are being treated for an infection such as a serious infection, or plan on becoming pregnant.

• Upper respiratory tract infection
• Urinary tract infection
• Nasal congestion
• Sore throat
• Runny nose
• Redness at the injection site

 

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Rheumatoid Arthritis Drugs: Glucocorticoids

Glucocorticoids are steroids. They are strong anti-inflammatory drugs that can also block other immune responses. These rheumatoid arthritis medications help relieve symptoms and may stop or slow joint damage. You receive these RA drugs by pill, or by injection.

Because of the risk of side effects, you should only use these RA drugs for brief periods, for example, when disease flares up or until DMARDs reach their full effectiveness. If your side effects are severe, don't stop taking the drug suddenly. Talk first with your doctor about what to do.

Examples of glucocorticoids:

 

Name Brand Name(s) Precautions Potential Side Effects

betamethasone

injectable

Celestone Tell your doctor if you have:
• Fungal infection
• History of TB
• Underactive thyroid
• Diabetes
• Stomach ulcer
• High blood pressure
• Osteoporosis
• Bruising
• Cataracts
• Increased cholesterol
•Atherosclerosis
• High blood pressure
• Increased appetite or indigestion
• Mood swings or nervousness
• Muscle weakness
• Osteoporosis
• Infections

prednisone

Rayos Tell your doctor if you have:
• Fungal infection
• History of TB
• Underactive thyroid
• Diabetes
• Stomach ulcer
• High blood pressure
• Osteoporosis
• Bruising
• Cataracts
• Increased cholesterol
•Atherosclerosis
• High blood pressure
• Increased appetite or indigestion
• Mood swings or nervousness
• Muscle weakness
• Osteoporosis
• Infections

 

Rheumatoid Arthritis Drugs: NSAIDs

NSAIDs work by blocking an enzyme that promotes inflammation. By reducing inflammation, NSAIDS help reduce swelling and pain. But they are not effective in reducing joint damage. These drugs alone are not effective in treating the disease. They should be taken in combination with other rheumatoid arthritis medications.

As with glucocorticoids, you should use them for brief periods -- they can cause severe digestive tract problems. Which type, if any, your doctor prescribes may depend upon your medical history. If you have a history of liver, kidney, heart problems or stomach ulcers, it's best to not take these drugs. Ask your doctor whether any new NSAIDS producing fewer side effects are available.

Examples of NSAIDs:
 

Name Brand Name(s) Precautions Potential Side Effects
celecoxib Celebrex • Tell your doctor if you have had a heart attack, stroke, angina, blood clot, or high blood pressure or if you have sensitivity to NSAIDS or sulfa drugs.
• Do not take with other NSAIDS.
• Do not take late in pregnancy.

• Increased risk of heart attack and stroke

Indigestion, diarrhea, and stomach pain
• Serious skin reactions

diclofenac sodium

Voltaren

Tell your doctor if you:
• Drink alcohol
• Use blood thinners
• Take ACE inhibitors, lithium, warfarin, or furosemide
• Have sensitivity to aspirin; kidney, liver, or heart disease; asthma; high blood pressure; ulcers
• Do not take with other NSAIDs.

• Abdominal cramps, diarrhea
• Dizziness or drowsiness
• Heartburn, indigestion, nausea, vomiting, ulcer, or bleeding
• Increased risk of blood clots, heart attacks, and stroke

Greater risk of complications for people with cardiovascular disease
ibuprofen Motrin, Advil

Tell your doctor if you:
• Drink alcohol
• Use blood thinners
• Take ACE inhibitors, lithium, warfarin, or furosemide
• Have sensitivity to aspirin; kidney, liver, or heart disease; asthma; high blood pressure; ulcers
• Do not take with other NSAIDS.

• increased risk of heart attack and stroke

Abdominal cramps, diarrhea
• Dizziness or drowsiness
• Heartburn, indigestion, nausea, vomiting, ulcer, or bleeding
• Increased risk of blood clots, heart attacks, and stroke

Greater risk of complications for people with cardiovascular disease

 

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Rheumatoid Arthritis Drugs: Analgesics

Analgesics reduce pain but they do not reduce swelling or joint damage.

There are a variety of over-the-counter and prescription analgesics. Narcotics are the most powerful type of analgesic. Use these carefully and be sure to let your doctor know if you have any history of alcoholism or drug abuse.

Examples of analgesics:
 

Name Brand Name(s) Precautions Potential Side Effects
acetaminophen Tylenol, Feverall • Tell your doctor if you have 3 or more drinks of alcohol daily.
• Avoid taking more than one product with acetaminophen.

Side effects uncommon if taken as directed.

tramadol

Ultram

• Tell your doctor if you use central nervous system depressants, tranquilizers, sleeping medications, muscle relaxants, or narcotic pain medications or if you have a history of drug or alcohol abuse.
• Do not stop suddenly or increase the dose on your own.

• Do not drive or use heavy machinery until you know how your body reacts to the drug.
• Constipation
• Diarrhea
• Drowsiness
• Increased sweating
• Loss of appetite
• Nausea
oxycodone, hydrocodone, and other narcotics OxyContin, Roxicodone

Tell your doctor if you use central nervous system depressants, tranquilizers, sleeping medications, muscle relaxants or narcotic pain medications or if you have a history of drug or alcohol abuse.
• Never chew or cut tablets; a high dose can be fatal if released rapidly.

• Constipation
• Dizziness
• Drowsiness
• Dry mouth
• Headache
• Increased sweating
• Itchy skin
• Nausea or vomiting
• Shortness of breath

 

WebMD Medical Reference Reviewed by David Zelman, MD on June 07, 2017

Sources

SOURCES: 

American College of Rheumatology: "Rheumatoid Arthritis."
Amgen Prescribing Information, Amjevita.
Arthur Kavanaugh, MD, rheumatologist; professor of medicine, University of California at San Diego.
Arthritis Foundation: "Drug Guide."
eMedicine Health: "Rheumatoid Arthritis."
FDA: "Therapeutics for Rheumatoid Arthritis." “FDA approves Inflectra, a biosimilar to Remicade.” "Prescribing Information, Infliximab-dyyb (Inflectra)." “FDA approves Amjevita, a biosimilar to Humira.”
Medscape: "FDA Approves Orencia."
Simponi. 
Singh, R. Current Opinion in Rheumatology; vol 17: pp 274-279.
WebMD Medical News: "New Rheumatoid Arthritis Drugs Work Well." "Celebrex Linked to Heart Attacks."
WebMD Medical Reference from Healthwise: "Rheumatoid Arthritis -- Medications."
WebMD Medical Reference provided in collaboration with Cleveland Clinic: "Arthritis Medicines Overview," "Steroids to Treat Arthritis," "Disease-Modifying Medications," "Biologics."

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