Medicines are the main treatment for rheumatoid arthritis. The types of medicines used depend on the severity of your disease, how fast it is progressing, and how it affects your daily life.
If your symptoms ease and you are in remission, you and your doctor will decide whether you can take less medicine or stop taking medicine. If your symptoms get worse, you will have to start taking medicine again.
Medicines to treat rheumatoid arthritis are used to:
- Relieve or reduce pain.
- Improve daily function.
- Reduce joint inflammation. Signs of joint inflammation include swelling, tenderness, and limited range of motion.
- Prevent or delay significant joint damage and deformity.
- Prevent permanent disability.
- Improve quality of life.
All people with rheumatoid arthritis are considered candidates for DMARD treatment. DMARDs can help prevent the significant joint damage that may occur in the early stages of rheumatoid arthritis. DMARDs are also called immunosuppressive drugs or slow-acting antirheumatic drugs (SAARDs).
Early treatment with DMARDs may significantly reduce disease severity. Experts recommend that DMARD treatment be continued for a prolonged period of time to sustain the benefit of disease control.8
DMARDS can be divided into two general categories based on how they work: oral DMARDs and biological DMARDs. Oral DMARDS are taken by mouth. They interfere with the making or working of immune cells that cause joint inflammation. Biological DMARDS are given by injection (infusion). They act in several different ways to affect how immune cells work. DMARDs decrease joint inflammation and damage.
Medicines may be given together. This is called combination therapy. Oral medicines are combined with each other or with biological DMARDs. But biological DMARDs are not used with each other because of a higher risk of infection.
Combination therapy may allow for lower doses of an individual drug to be used, which may reduce the risk of side effects that can occur with higher doses. Combination therapy may be an effective way to reduce symptoms of rheumatoid arthritis, control the disease, and prevent it from getting worse. And you may need fewer treatment adjustments with combination therapy than with treatment using individual medicines.
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Some medicines for rheumatoid arthritis may cause birth defects. If you are pregnant or are trying to become pregnant, talk with your health professional about your medicines.
Medication Choices
Medications to slow the progression of disease: Disease-modifying antirheumatic drugs (DMARDs) are usually started within 3 months of your diagnosis and are used to control the progression of rheumatoid arthritis and to try to prevent joint deterioration and disability. DMARDs are often given in combination with other DMARDs or with other medications, such as corticosteroids or nonsteroidal anti-inflammatory drugs (NSAIDs).Commonly used oral DMARDs:
- Antimalarial medications such as hydroxychloroquine (Plaquenil) or chloroquine (Aralen)
- Leflunomide (Arava)
- Methotrexate such as Rheumatrex
- Sulfasalazine such as Azulfidine
- Azathioprine such as Imuran
- Cyclophosphamide such as Cytoxan or Neosar
- Cyclosporine such as Neoral or Sandimmune
- Gold salts such as Ridaura or Aurolate
- Minocycline such as Dynacin or Minocin
- Penicillamine such as Cuprimine or Depen
- Abatacept (Orencia)
- Adalimumab (Humira)
- Anakinra (Kineret)
- Etanercept (Enbrel)
- Infliximab (Remicade)
- Rituximab (Rituxan)
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, or naproxen. NSAIDs are used to control pain and may help reduce inflammation. They do not control the disease or stop it from getting worse. NSAIDs may be combined with disease-modifying antirheumatic drugs (DMARDs).
- Corticosteroids such as prednisone or Medrol. Corticosteroids are used to reduce disease activity and joint inflammation. But using corticosteroids as the only therapy for an extended time is not considered the best treatment. Corticosteroids are often used to control symptoms and flares of joint inflammation until DMARDs reach their full effectiveness, which can take up to 6 months.
- Analgesics (pain relievers). These do not reduce inflammation but may assist with pain control. Commonly used prescription analgesics include:
- Acetaminophen with codeine (such as Tylenol with codeine).
- Acetaminophen with hydrocodone (such as Vicodin).
- Tramadol.
- Propoxyphene (such as Darvon).
- Nonprescription acetaminophen, which may be used to reduce pain.
What to Think About
Some DMARDs can take up to 6 months to work. In some people, a certain DMARD may not work at all, and a different DMARD will be used. Rapid improvement should not be expected. Medications for rheumatoid arthritis are best managed by a doctor who specializes in inflammatory diseases of the joints (rheumatologist).Many DMARDs have serious side effects. Regular blood and urine tests are usually needed when using a DMARD to monitor the drug's effects on blood-producing cells (bone marrow), the kidneys, and the liver.
Experts are studying many medicines that might be used for rheumatoid arthritis. Examples include:
- Tacrolimus (Prograf), an inhibitor of a protein called calcineurin. In one 6-month trial, people who had rheumatoid arthritis that had not responded to DMARD treatment experienced a reduction in disease activity and symptoms.14
- Tocilizumab, another biological DMARD that slows inflammation by inhibiting cytokine function. The results of research trials suggest that tocilizumab may reduce disease activity in rheumatoid arthritis.15
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