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Rheumatoid Arthritis (RA) Medications

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Rheumatoid arthritis medications list

Analgesics

Analgesics, or painkillers, are a staple of RA treatment. Mild-to-moderate RA pain can usually be treated with non-opioid analgesics. But for severe pain, opioids and opioid combinations are more effective. That increased effectiveness does come with the potential for side effects, including drowsiness and constipation.

Non-Opioid Medications

Combination Products: Opioids plus Other Analgesics

Opoids (single ingredients)

Opioid Agonists/Antagonists

Anti-Inflammatory Medications

This class of drugs is also known as non-steroidal anti-inflammatory drugs (NSAIDs). They work by inhibiting and/or interfering with chemicals in the body which cause inflammation. The most common drawback to NSAID use is their propensity to cause stomach and gastrointestinal bleeding.

Biologic Agents

Biological drugs are proteins manufactured using recombinant DNA technology. They are immunosuppressants that target and block the action of cells or chemicals that enable the immune system to cause inflammation and other symptoms of RA. Biological agents are called disease-modifying antirheumatic drugs (DMARDs) because by suppressing components of the immune system they reduce symptoms and reverse the course of RA.

Janus Kinase (JAKs) Inhibitor

JAK inhibitors are the newest class of drugs used to treat RA. They work by blocking Janus kinase JAKs) enzymes located within stem cells and other cells. JAKs enzymes are involved in stimulating immune responses that contribute to symptoms of RA. Therefore, inhibiting JAKs enzymes reduces symptoms of RA.

Tofacitinib (Xeljanz) is an oral drug and is the first JAKs inhibitor approved by the FDA.

Corticosteroids

Corticosteroids are synthetic versions of anti-inflammatory chemicals normally produced in the body. They are powerful, but long-term use can result in severe side effects, including weaker bones and a depressed immune system.

Disease-Modifying Antirheumatic Drugs (DMARDs)

DMARDs don't just relieve pain and/or inflammation of RA, they actually can alter the course of the chronic disease, and help stop some of the damage from getting worse. DMARDs include the biological drugs listed above as well as non-biological drugs listed below.

What are the new classes of rheumatoid arthritis medications?

Tofacitinib (Xeljanz) is the newest medication available for rheumatoid arthritis. Known as a JAKs inhibitor, tofacitinib works by inhibiting certain enzymes involved the inflammatory process.

What are effective over-the-counter medications for rheumatoid arthritis?

Most patients with Rheumatoid Arthritis (RA) will, at some point, use over-the-counter medications to control pain -- most commonly, acetaminophen (Tylenol). Other OTC medications which can help with RA pain and inflammation include aspirin and non-prescription versions of ibuprofen (Advil, Motrin) or naproxen (Aleve). In addition, some topical pain medications may also provide relief. These ointments and creams are generally divided into three categories:

Salicylates

Salicylates are derivatives of aspirin. In topical form, they are absorbed through the skin and exert a local, anti-inflammatory (and thus pain-relieving) effect.

  • Aspercreme
  • BenGay
  • IcyHot
  • Myoflex
  • Salonpas
  • Theragesic
  • Trolamine

Capsaicin

Capsaicin both stimulates and inhibits pain signals in the body.

  • Capsazin
  • Zostrix

Counter-Irritants

Counter-irritants work by creating a sensation in one location, to draw attention away from a source of pain in another.

  • Mineral Ice

What are effective natural medications for rheumatoid arthritis?

A few natural remedies may help patients with rheumatoid arthritis. Omega-3-fatty acids, found in fish oil capsules, may reduce inflammation. The same would be true for gamma linoleic acid. Herbal preparations with possible benefit include ginger, Devil's claw, and white willow.

What are the potential risks and benefits of injectable medications for rheumatoid arthritis?

Biologic agents used to treat RA need to be injected. The biggest benefit of these drugs is that they are very effective. Biologics not only relieve symptoms, but also halt damage to joints and they generally provide quick relief. The biggest drawback of biologic agents is cost. Patients can spend thousands of dollars a month using biologics. Other drawbacks include side effects, which may be severe because biologics suppress the immune system, enhancing the possibility of infections. In addition patients may not like receiving injections.

What are the best rheumatoid arthritis medications for pain?

Most of the medications used for rheumatoid arthritis provide relief from pain. However, depending on current disease activity, some may be more effective than others. For acute flare-ups, for example, short-term treatment with a corticosteroid, such as prednisone, may be highly beneficial. If there is excessive inflammation, a non-steroidal anti-inflammatory can address that symptoms and also relieve pain. Over-the-counter analgesics, such as acetaminophen, may be used for minor pain. But for chronic, moderate-to-severe pain, an opioid analgesic would be more effective. Pain and inflammation are both addressed by biological drugs which have the added benefit of altering disease activity.

What are the side effects of rheumatoid arthritis medications?

Analgesics

Acetaminophen may cause damage to the liver in excessive doses.

Aspirin has the potential to cause stomach bleeding.

Opioid analgesics may cause drowsiness, confusion, reduced respiratory rate, constipation, and have the potential for addiction.

Nonsteroidal Anti-Inflammatories

  • Gastrointestinal irritation with possible bleeding
  • Some may cause drowsiness (piroxicam)
  • Kidney damage

Biologic Agents

  • Irritation at injection site
  • Allergic reactions
  • Increased susceptibility to infection

Corticosteroids (Long-term use)

Disease-Modifying Antirheumatic Drugs

Azathioprine (Imuran)

  • Potentially serious blood disorders
  • Increased risk for some cancers

Auranofin (Ridaura)

  • Potentially serious, even fatal, blood disorders
  • Kidney problems
  • Mouth sores
  • Diarrhea

Chloroquine (Aralen), Hydroxychloroquine (Plaquenil)

  • Vision problems
  • Hearing problems
  • Seizures
  • Musculoskeletal issues, including weakness and lack of coordination

Cyclophosphamide (Cytoxan)

Cyclosporine (Sandimmune)

  • Increased risk for some cancers
  • Increased risk for serious infections
  • Kidney damage
  • High blood pressure

Leflunomide (Arava)

Methotrexate (Rheumatrex)

  • Nausea
  • Vomiting
  • Mouth sores
  • Liver damage with long term use
  • Serious blood problems

Gastrointestinal side effects can be greatly diminished by taking a folic acid supplement.

Minocycline (Minocin)

Mycophenolate (CellCept)

Penicillamine (Cuprimine)

  • Kidney damage
  • Serious, even fatal, blood disorders
  • Liver abnormalities
  • Pemphigus
  • Allergic reactions

Sulfasalazine (Azulfidine)

  • Nausea
  • Abdominal pain
  • Increased susceptibility to sunburn
  • Orange colored urine and/or skin
  • Possible changes in blood cell count

RA Drugs with the Least Side Effects

Taken at the proper dose, acetaminophen carries the lowest risk for side effects. However, exceeding the recommended dose can result in severe, even fatal, liver damage.

What are the side effects of rheumatoid arthritis medications?

RA Drugs That Can Cause Weight Gain

  • Corticosteroids

RA Drugs That Are Preferred during Pregnancy

  • Sulfasalazine (Azulfidine)
  • Chloroquin (Aralen)
  • Hydroxychloroquine (Plaquenil)
  • Corticosteroids
  • Nonsteroidal Anti-Inflammatories (Until 32 weeks)
  • Cyclosporin
  • Azathioprine
  • Anti-TNF Biologic Agents

RA Drugs That Are Not Recommended during Pregnancy

  • Methotrexate (Rheumatrex)
  • Mycophenolate (CellCept)
  • Cyclophosphamde (Cytoxan)
  • Rituximab (Rituxan)

What rheumatoid arthritis medications are in development?

Rheumatoid arthritis treatment is an active area of research. In fact, according to the Pharmaceutical Research and Manufacturers of America, more than 50 drugs for rheumatoid arthritis are in various stages of clinical testing. Many of these are new biologics. Others target histamine receptors and glucocorticoid receptors.

What are the treatment options if rheumatoid arthritis medications are not working?

Fortunately, if one RA drug is not working, there are others to switch to – and this commonly happens. Also, combinations of drugs sometimes work better than one drug alone.

To complement drug therapy, doctors recommend that patients with RA should engage in a regular exercise program to help strengthen joints and maintain flexibility. Physical therapy can also help develop better range of motion in affected joints. Use of heat and/or cold can provide pain relief and loosen stiff joints. Massage, acupuncture and rest all may be useful in alleviating RA symptoms.

REFERENCES:

"Using Biologics to Treat Rheumatoid Arthritis: Comparing Effectiveness, Safety, Side Effects, and Price." ConsumerReports Health

"Side Effects of Nine Commonly Used Biologics." Cochrane Database of Systematic Reviews.

"Pregnancy and Rheumatic Disease." American College of Rheumatology.

"Medicines in Development Arthritis 2014." Pharmaceutical Research and Manufacturers of America.

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