While there is no definite cure for RA or rheumatoid arthritis to date, there are a range of available medications in the market that are designed to alleviate its symptoms and ultimately improve the condition.
In general, medications for rheumatoid arthritis can be classified into distinctive categories, as described below. Physicians will often develop an appropriate treatment plan to manage joint pain and inflammation, as well as prevent cell damage in the joints. Depending on the specific case, effective treatment can be accomplished through a combination of each of the succeeding drugs:
NSAIDs or Nonsteroidal Anti-Inflammatory Drugs
Nonsteroidal Anti-inflammatory Drugs, commonly known as NSAIDs, are effective in relieving pain and reducing inflammation, but do not serve to prevent further damage to the joints. NSAIDs prevent the human body from producing a substance called prostaglandins, which is primarily responsible for generating inflammation and pain.
Common NSAID examples are naproxen (Naprosyn, Aleve) and ibuprofen (Motrin, Advil). Other examples include ketoprofen (Orudis), etodolac (Lodine), meloxicam (Mobic), Celecoxib (Celebrex), indomethacin, oxaprozin (Daypro), diclofenac (Cataflam, Voltaren), piroxicam (Feldene), and nabumetone (Relafen).
NSAIDs are often recommended once a definite diagnosis of rheumatoid arthritis is made. However, when taken in high dosages for prolonged periods, these drugs can produce severe side effects, including stomach bleeding, gastric ulcers, and even kidney and liver damage.
Corticosteroids
Another group of medication used for rheumatoid arthritis treatment is corticosteroids. These drugs suppress the immune system, thus reducing inflammation.
Cortisone (Cortone), methylprednisolone (SoluMedrol, DepoMedrol), betamethasone (Celestone Soluspan), triamcinolone (Aristocort), dexamethasone (Decadron), prednisolone (Delta-Cortef), and prednisone (Deltasone, Orasone), are some examples of corticosteroids.
Although corticosteroids can be effective in treating rheumatoid arthritis, they are known to trigger adverse effects when used in extended periods of time. Some of these side effects include easy bruising, glaucoma, cataracts, thinning bones, and excessive weight gain, and diabetes. Because of their potential to develop severe side effects, these medications are often only used as a short-term remedy to manage sudden outbreaks of the disease. On the plus side, a single injection of the drug can inhabit inflammation of a specific joint for a long period of time.
DMARDs or Disease Modifying Anti-Rheumatic Drugs
DMARDs are a group of medications that act to suppress the immune system from attacking the joints, thus retarding the progression of further joint damage. In treating rheumatoid arthritis, DMARDs are frequently taken together with other medications for increased efficiency.
Rheumatoid arthritis commonly causes permanent joint damage, which starts to manifest at the onset. For this reason, most physicians would recommend DMARD therapy immediately upon diagnosis. Patients are most responsive to DMARDs during the early stages of RA. The sooner the medication is taken, the more beneficial it is for the patient.
Some DMARD examples include methotrexate (Rheumatrex), cyclosporine (Sandimmune, Neoral), hydroxychloroquine (Plaquenil), gold salts (Solganal, Ridaura, Myochrysine, Aurolate), cyclophosphamide, azathioprine (Imuran), penicillamine (Cuprimine), minocycline, leflunomide (Arava), and sulfasalazine (Azulfidine).
Though some DMARD products have been proven effective in RA treatment, the potential for severe side effects is enormous. Long-term usage of DMARDs can lead to bone marrow and liver toxicity, susceptibility to infections, skin allergies, and even autoimmunity.
Among the examples of DMARDs previously listed, hydroxychloroquine has the least risk of causing bone marrow and liver toxicity, and is therefore considered to be one of the safest DMARD types. Unfortunately, hydroxychloroquine is not a particularly powerful medication, and is not strong enough on its own to control the symptoms of rheumatoid arthritis.
Conversely, methotrexate is considered to be one of the most powerful DMARDs to use in RA treatment due to a number of reasons. It has been known to effectively fight RA without causing bone marrow and liver toxicity like most other DMARDs. In addition, methotrexate works safely and effectively when used alongside biological agents, which are another group of RA drugs discussed below. Thus, it is frequently prescribed in combination with biological agents in cases where the drug fails to adequately treat rheumatoid arthritis on its own. However, it should be noted that although methotrexate is not as risky as others, it still has the potential to suppress the bone marrow or cause hepatitis. In such cases, regular blood tests are always advised to efficiently monitor the patient's condition, as well as to stop treatment at the first indication of trouble.
Biological Agents
Biological agents, also known as biological drugs, serve to reduce inflammation through various ways.
One means through which biological agents work is by blocking TNFs or tumor necrosis factors. Infliximab (Remicade), adalimumab (Humira), and etanercept (Enbrel) are some examples of TNF blockers.
Another way with which biological agents alleviate inflammation is by killing B cells. The drug Rituximab (Rituxan), in particular, binds itself to B cells, ultimately destroying them.
Other medications that lessen inflammation in their own distinctive ways are:
- tocilizumab (Actemra, RoActemra), which works by blocking interleukin 6 or IL-6
- anakinra (Kineret), which serves to block interleukin 1 or IL-1
- abatacept (Orencia), which functions by blocking T-cells
One thing to consider is that each of these biological agents has its own potential for specific adverse side effects. Careful consideration should be given to the drug's side effects when prescribing it to a patient.
Salicylates
Salicylates serve to reduce prostaglandins production. Prostaglandins cause the painful and inflammatory symptoms of arthritis. In recent years, salicylates have been widely replaced with NSAIDs, primarily because the former can cause severe side effects, e.g. potentially damaging kidney function.
Pain Relief Medications
Last but not least, a variety of pain relief medications may also be used in rheumatoid arthritis treatment. Examples of medications which have the primary purpose of pain relief include tramadol (Ultram) and acetaminophen (Tylenol).
Although anti-pain medication neither reduces inflammation nor delays joint damage progression, it allows the patient to feel more comfortable and ultimately function better in his/her daily life. For this reason alone, pain relief medications are definitely worth mentioning.
Surgery as a Last Resort
If the medications listed above prove ineffective, doctors may recommend surgery. Surgical procedures used in RA treatment include tendon repair, joint lining removal (synovectomy), and arthroplasty or joint replacement surgery, wherein the damaged parts of the joint are replaced with prosthetics.
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