Rheumatoid Arthritis: Medicines

Rheumatoid arthritis (RA) is a long-term or chronic autoimmune condition. In RA, the body's immune system actually attacks the joints. Inflammation in the synovium or joint lining happens. This causes the symptoms of pain, swelling, and difficulty with movement. Most people also have symptoms affecting the rest of their bodies. For example, fever and body aches. Over time, lasting (permanent) joint damage may happen. That is why early treatment is so important. Treatment not only includes medicines, but also:

• Lifestyle changes. Weight management and exercise, including range of motion to keep your joints moving

• Joint protection. Changing the way you do things and using assistive devices to protect your joints from damage

• Natural and alternative treatments. Use of heat and cold, acupuncture, biofeedback, and massage are just some of the therapies

• Learning to deal with RA. Relaxation techniques and counseling

There are many different medicines used to treat RA. Because RA can be complicated, it is best managed by rheumatologists or specialists in arthritis and other conditions. The medicines that may be prescribed include the following.

Nonsteroidal anti-inflammatory drugs (NSAIDs) 

NSAIDs help to lessen pain and inflammation. They are available over-the-counter and by prescription. Ibuprofen and naproxen sodium are common over-the counter NSAIDs. There are also several prescription NSAIDs. NSAIDs can cause stomach problems. These include bleeding, as well as other side effects. One, NSAID that is safer for the stomach is celecoxib. But it may cause other side effects. Talk with your healthcare provider before taking these medicines.

Corticosteroids

Corticosteroids or steroids are strong anti-inflammatory medicines. They can quickly control inflammation. Prednisone, prednisolone, and methylprednisolone are commonly used steroid medicines. They are used short-term because of serious side effects. Steroids can be taken by mouth (orally) or injected into affected joints. 

Traditional disease-modifying antirheumatic drugs (DMARDs)

DMARDs change the course of RA. They are often started soon after diagnosis to prevent joint damage. Using a DMARDS early on has been shown to help prevent worsening of disease. Methotrexate is used most often.

Biologic DMARDs

Biologic agents or biologics also change the course of RA. Each of the medicines slows inflammation and prevents damage to the joints. There are several biologics used to treat RA. Biologics may help some people with RA who haven't responded to other medicines. Traditional biologic medicines include abatacept, adalimumab, anakinra, certolizumab, etanercept, golimumab, infliximab, rituximab, tocilizumab, sarilumab and tofacitinib. Traditional biologic medicines can be given by injection under the skin (subcutaneously) or into a vein (intravenously). 

Small molecule DMARDs

A new class of DMARDs that are given by mouth were introduced in 2013. The only FDA-approved small molecule DMARD is tofacitinib. 

DMARDs and biologics

The American College of Rheumatology, made up of experts in arthritis treatment, have set guidelines for using DMARDs and biologic agents. The recommendations help healthcare providers know which medicines to use, as well as how and when to make changes. And because these medicines increase the chance of serious infections, they also guide healthcare providers about when to screen for tuberculosis and what vaccinations to take.

Work with your rheumatologist to find the medicines that work best for you. Your healthcare provider may try different medicines or combinations of them. In order to get the most benefit and lessen the chance of side effects, make sure you go to all appointments, get all recommended tests and vaccines, and carefully follow all instructions.