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Medications for Rheumatoid Arthritis

The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included. Ask your doctor if you need to take any special precautions. Use each of these medications only as recommended by your doctor and according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.
There are a variety of medications available to treat the pain and inflammation of rheumatoid arthritis (RA). In some cases, the medications are used in combination.
You may have to try different medications before you find the one that works best for you with the least number of side effects.

Prescription Medications

  • Naproxen (Naprosyn, Anaprox, Aleve)
  • Ketoprofen (Orudis)
  • Ibuprofen (Motrin, Advil, Nuprin)
  • Indomethacin (Indocin)
  • Sulindac (Clinoril)
  • Meclofenamate (Meclomen)
  • Ketorolac (Toradol)
  • Piroxicam (Feldene)
  • Diclofenac sodium (Voltaren, Cataflam)
  • Celecoxib (Celebrex)
  • Meloxicam (Mobic)
  • Azathioprine (Imuran)
  • Cyclophosphamide (Cytoxan)
  • Cyclosporin
  • D-penicillamine (Depen)
  • Hydroxychloroquine sulfate (Plaquenil)
  • Leflunomide (Arava)
  • Methotrexate (Rheumatrex, Trexall )
  • Sulfasalazine (Azulfidine)
  • TNF-inhibitors
  • Interleukin-1 receptor blockers
  • Biologic response modifier and disease-modifying antirheumatic drug
  • Monoclonal antibody
  • Interleukin-6 receptor antagonist
  • Prednisone (Deltasone, Cortan)
  • Methylprednisolone (Medrol)

Over-the-counter Medications

Prescription Medications

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
Common names include:
  • Naproxen (Naprosyn, Anaprox, Aleve)
  • Ketoprofen (Orudis)
  • Ibuprofen (Motrin, Advil, Nuprin)
  • Indomethacin (Indocin)
  • Sulindac (Clinoril)
  • Meclofenamate (Meclomen)
  • Ketorolac (Toradol)
  • Piroxicam (Feldene)
  • Diclofenac sodium (Voltaren)
Although some nonsteroidal anti-inflammatory agents (NSAIDs) are available as over-the-counter medications, you may still be given a prescription in order to obtain a higher dosage. NSAIDs help decrease inflammation, swelling, and joint pain.
Be sure to take NSAIDs with food to decrease the chance of stomach irritation.
Drinking alcoholic beverages or taking other NSAIDs, COX-2 inhibitors, aspirin, or steroids while you are already using an NSAID can increase your risk of side effects.
Possible side effects include:
  • Stomach upset
  • Stomach ulcers
  • Kidney damage
  • Liver inflammation
  • Confusion or lightheadedness
  • Severe allergic reaction (hives, difficulty breathing, swelling around the eyes)
  • Increased risk of bleeding—always inform your doctors that you’re taking an NSAID before having any medical or dental procedures or surgeries
  • Asthma
  • Possible increased risk of heart attack
Cyclooxygenase-2 or COX-2 Inhibitors
Common names include:
  • Celecoxib (Celebrex)
  • Meloxicam (Mobic)
COX-2 inhibitors work in a way similar to NSAIDs, helping to decrease inflammation, swelling, and joint pain. The way the medications do this allows them to work without causing the same degree of stomach irritation. In particular, COX-2 inhibitors cause far fewer stomach ulcers than do NSAIDs. But because there is an increased risk of heart attacks and strokes associated with these medications, doctors generally reserve them for use in people who cannot take traditional NSAIDS and who have no risk factors for cardiac disease.
Drinking alcoholic beverages or taking NSAIDs, aspirin, or steroids while you are using a COX-2 inhibitor can increase your risk of side effects.
Possible side effects include:
  • Stomach upset
  • Liver inflammation
  • Confusion
  • Severe allergic reaction (hives, difficulty breathing, swelling around the eyes)
  • Kidney disease
  • Congestive heart failure
  • Asthma
Disease-modifying Antirheumatic Drugs (DMARDs)
Common names include:
  • D-penicillamine (Cuprimine, Depen)
  • Hydroxychloroquine sulfate ( Plaquenil )
  • Methotrexate (Rheumatrex)
  • Cyclophosphamide (Cytoxan)
  • Cyclosporine
  • Azathioprine (Imuran)
  • Leflunomide (Arava)
These drugs are given in an effort to slow or halt the progression of rheumatoid arthritis. They are all immunosuppressive agents. Because rheumatoid arthritis is believed to be caused by an overactive immune system, it is hoped that calming the immune system’s activity will slow the progression of rheumatoid arthritis.
Possible side effects include:
  • Nausea
  • Diarrhea
  • Liver inflammation
  • Bladder inflammation
  • Kidney damage
  • Nerve damage
  • High blood pressure
  • Infections
  • Lung inflammation
  • Muscle and nerve inflammation
Corticosteroids
Common names include:
  • Prednisone (Deltasone, Cortan)
  • Methylprednisolone (Medrol)
Corticosteroids are very potent anti-inflammatory agents and are given to reduce swelling, inflammation, and joint pain.
Possible side effects for short-term use (about three weeks or less) include:
  • Difficulty sleeping
  • Increased appetite
  • Mood swings, increased emotionality
  • Increases in blood pressure
  • Increased blood sugar (especially in people with diabetes)
Possible side effects for long-term use (about three weeks or longer) include:
Biologic Response Modifiers
Common names include:
  • TNF-inhibitors, such as:
    • Etanercept (Enbrel)—restricted in the US
    • Infliximab (Remicade)
    • Adalimumab (Humira)
    • Golimumab (Simponi)
    • Certolizumab (Cimzia)
  • Interleukin-1 receptor inhibitors—Anakinra (Kineret)
  • Biologic response modifier and disease-modifying antirheumatic drug (DMARD)—Abatacept (Orencia)
  • Monoclonal antibody—Rituximab (Rituxan)
  • Interleukin-6 receptor antagonist—Tocilizumab (Actemra)
These medications are given when other drugs haven’t worked. Etanercept, adalimumab, and anakinra are given by injection. Infliximab, orencia, and rituximab are given by IV infusions. They can help decrease the symptoms of rheumatoid arthritis. They may also increase your risk of contracting infections. You need to inform your healthcare provider that you are taking these medications before you get any immunizations. Also TNF-inhibitors can increase the risk of Hodgkin’s and non-Hodgkin’s lymphoma and other types of cancer in children and adolescents.
Before you start taking any of these medications, you will need a TB test to make sure you do not have a hidden case of tuberculosis. You will need to have your heart monitored while you take this medication. Contact your healthcare provider immediately if you develop any of the following symptoms after receiving one of these medications:
  • Chest pain
  • Difficulty breathing
  • Fever and chills
  • Productive cough
  • Itching
  • Hives
  • Flushed face
  • Rashes
  • Confusion
  • Weakness
  • Injection site reactions

Over-the-counter Medications

Acetaminophen
Acetaminophen can be helpful in relieving some of the pain associated with rheumatoid arthritis. Do not take a larger dose than is recommended by your healthcare provider. Do not drink alcoholic beverages while you are taking acetaminophen.
Capsaicin Cream
Common brand name: Zostrix
Capsaicin cream is rubbed on the skin of an affected joint to relieve the pain and inflammation of rheumatoid arthritis.
It is made using the active ingredient of hot chili peppers. Some people prefer to wear rubber gloves while applying the cream. If you do not, be sure to wash your hands very thoroughly with soap and water after using the cream. Be very careful not to get the cream near your eyes, as it will burn and sting. If you do get some in your eyes, flush them thoroughly with cool water.
Possible side effects include burning, stinging, or warm sensation when first applied to the skin.

Special Considerations

If you are taking medications, follow these general guidelines:
  • Take your medication as directed. Do not change the amount or the schedule.
  • Do not stop taking them without talking to your doctor.
  • Do not share them.
  • Know what the results and side effects may be. Report them to your doctor.
  • Some drugs can be dangerous when mixed. Talk to a doctor or pharmacist if you are taking more than one drug. This includes over-the-counter medication and herb or dietary supplements.
  • Plan ahead for refills so you do not run out.

References

Rheumatoid arthritis. Arthritis Foundation website. Available at: http://www.arthritis.org/conditions-treatments/disease-center/rheumatoid-arthritis . Accessed August 21, 2013.

Rheumatoid arthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Rheumatic%5FDisease/default.asp . Updated April 2009. Accessed August 21, 2013.

Rheumatoid arthritis (RA). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.ebscohost.com/about/about-us . Updated July 2, 2013. Accessed August 21, 2013.

11/4/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Tumor necrosis factor (TNF) blockers (marketed as Remicade, Enbrel, Humira, Cimzia, and Simponi). US Food and Drug Administration website. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm175843.htm . Updated August 31, 2009. Accessed August 21, 2013.

12/31/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Anis A, Zhang W, Emery P, et al. The effect of etanercept on work productivity in patients with early active rheumatoid arthritis: results from the COMET study. Rheumatology (Oxford) 2009;48:1283-1289.

1/29/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : FDA approves new drug for rheumatoid arthritis. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm197108.htm . Updated January 11, 2010. Accessed August 21, 2013.

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