Rheumatoid Arthritis Ra Medications

One of the priorities of rheumatoid arthritis treatment is pain relief as joint inflammation can cause severe pain and loss of mobility. The pain can restrict daily life, and often people give up an active lifestyle in an attempt to keep pain to a minimum. Adequate pain relief is the first step in gaining control over arthritis.

NSAIDs and Analgesics

NSAIDs are non-steroidal anti-inflammatory drugs used to relieve inflammation. The family includes a wide range of both prescription and non-prescription medications. NSAIDs work quickly to reduce inflammation: Relief is usually felt within hours. Most NSAIDs are also analgesics (general painkillers). Analgesic medications alone do not reduce inflammation, the primary cause of rheumatoid arthritis pain.

Aspirin

Aspirin has been used to fight rheumatoid arthritis pain for many years. It’s inexpensive, available without a prescription and can help prevent heart attacks and strokes.

Aspirin does, however, have some serious drawbacks as an arthritis pain reliever: Multiple doses are necessary for effective treatment. Overuse, or sensitivity to the drug, can cause gastrointestinal bleeding. In severe cases, gastrointestinal bleeding can cause death. As a result, aspirin has generally been replaced by ibuprofen and other NSAIDs as a rheumatoid arthritis treatment.

If you use blood thinners or drink alcohol, inform your doctor before using aspirin. Also report any allergies or medical disorders to your doctor.

Ibuprofen and Other NSAIDs

Ibuprofen is a non-prescription NSAID that is commonly prescribed as a first line of treatment for rheumatoid arthritis pain. More potent prescription NSAIDs include fenoprofen, indomethacin, and naproxen. All NSAIDs should be taken with food or milk. Some people find that taking the medication with an antacid prevents stomach problems. Consult your doctor before combining NSAIDs with antacids or any other form of medication.

Common side effects of ibuprofen include stomach problems, diarrhea, drowsiness and dizziness. Headaches, heartburn and nausea may also occur. Other serious potential problems can include gastric bleeding, renal difficulties, kidney and liver problems, hypertension and fluid retention.

Humira (adalimumab)

Adalimumab is a protein injected under the skin to block the body’s production of tumor necrosis factor alpha (TNF alpha). TNF is a protein that the body produces to repair injuries. TNF causes inflammation, a natural part of the healing process, but can greatly aggravate symptoms of rheumatoid arthritis.

Because it blocks TNF production, Humira (adalimumab) reduces inflammation and the signs of inflammation in arthritis, including fever, achiness, pain and swelling around the joints. Unfortunately, blocking the body’s TNF production also makes the immune system more susceptible to certain autoimmune disorders and cancer.

Similarly, taking Humira may lower the body’s count of good blood cells needed to fight off infections, making it more likely that individuals may get sick or bleed severely if injured. Taking Humira has also been associated with serious infections like tuberculosis (TB) and sepsis (bacteria in the blood). Other side effects of taking Humira include:

  • headaches
  • itching and swelling around the injection site
  • nausea
  • rash and redness
  • respiratory infections.

If you are taking Humira or another TNF-blocking drug for the treatment of Rheumatoid Arthritis and begin to develop a fever, cough, flu-like symptoms or other signs of infection, you should immediately call your doctor.

Corticosteriods: Advantages and Disadvantages

Corticosteroids such as cortisone and prednisone are effective anti-inflammatories. However, their use should be limited due to their many side effects. People who need additional pain relief during rheumatoid arthritis flare-ups find short-term corticosteroid use helpful. Most doctors advocate using the smallest dose of corticosteroids for the shortest period of time possible. Corticosteroids can also be injected directly into a joint for temporary pain relief. Mild side effects of corticosteroid use include increased appetite, stomach upset and nervousness. Long-term use of corticosteroids or high doses of the medication can cause serious side effects, which include:

A condition known as Cushing’s syndrome can also develop with extended use. The signs and symptoms of Cushing’s include a round, “moon-like” face, weight gain, weak muscles, thin skin and fragile, brittle bones.

Not for RA: Hyalgan and Synvisc

Hyalgan® and Synvisc® are appropriate medications for osteoarthritis, not rheumatoid arthritis. People often confuse the two forms of arthritis and how to treat them. Both Hyalgan and Synvisc are injected directly into the joint to improve the joint’s fluid content or amount of synovial fluid. Rheumatoid arthritis inflammation generally produces excess synovial fluid, so treatment with Hyalgan or Synvisc would not relieve symptoms, and could actually make them worse.

Disease-Modifying Drugs

Disease-modifying anti-rheumatic drugs (DMARDs), don’t just treat the symptoms of RA; they can actually slow the progression of joint deterioration. Media attention has focused much attention on DMARDs, and a number of popular misconceptions about the drugs have arisen. Some medications are commonly believed to be DMARDs and actually belong to other drug families. Others are not suitable treatments for rheumatoid arthritis.

Arava: Arava® is a disease-modifying drug that treats rheumatoid arthritis by targeting the white blood cells that contribute to the inflammatory process. By impairing the function of these white blood cells, called T lymphocytes, Arava relieves the tenderness and swelling caused by inflammation. The medication also slows joint deterioration. Arava is taken orally once a day, and may take up to four weeks before effects are felt.

Before starting Arava, tell your doctor about any medical conditions or allergies you may have, as well as any medication you’re currently taking. People with immune system deficiencies, high rates of infection, liver disease, kidney disease or hepatitis B or C should not take Arava. The drug can cause fetal death or birth defects, so women who are pregnant or plan to become pregnant should not use the drug.

Side effects can include diarrhea, easy bruising, stomach problems, hair loss, rashes, fatigue, and a heightened infection rate. Report any of these conditions to your doctor. If you experience severe skin reactions or mouth sores, call your doctor immediately. Arava can also cause low blood cell counts and an increase in liver enzymes, so periodic blood testing is required.

Enbrel: Enbrel® is a biologic agent designed to control rheumatoid arthritis by suppressing chemicals that cause inflammation. Synthetic immune system suppressors generally impair the entire immune system, while biological disease-modifying drugs such as Enbrel act only on a portion of the system. Enbrel blocks TNF (tumor necrosis factor), a chemical that contributes to inflammation. The medication both controls symptoms and slows joint damage.

Administration is by injection, twice a week. Enbrel is not suitable for people suffering from severe infections, or in uncontrolled diabetes. Avoid starting Enbrel if you have an existing infection.

Side effects can be serious. Some patients have reported nervous system disorders, including seizures, multiple sclerosis and eye inflammation. Serious blood disorders can also occur. Deaths have been reported, although the connection with Enbrel is unclear. The most common side effect is an injection site reaction.

If you experience bruising, fever, bleeding or paleness while taking Enbrel, call your doctor immediately.

Remicade: Remicade® slows rheumatoid arthritis joint damage by blocking the inflammation-causing chemical TNF. This disease-modifying drug was originally designed to fight inflammation caused by Crohn’s disease. Remicade is administered intravenously once a month, usually in combination with the older DMARD methotrexate.

Remicade users have reported cases of tuberculosis and sepsis-bacterial infection of internal organs. If you have TB, or come into contact with someone who does, tell your doctor before starting Remicade. Monitor any infections closely while taking Remicade.

Common side effects include headaches, nausea, sinusitis, rashes, itchy skin, coughing and an increase in upper respiratory diseases. Call your doctor if you experience hives or breathing problems. Remicade can also cause a drop in blood pressure.

Older DMARDs

Older rheumatoid arthritis treatments include the use of anti-malarial drugs, sulfasalazine, and gold compounds. Some, such as methotrexate and cyclophosphamide, suppress the entire immune system. While still used, these treatments can cause severe toxic side effects, so they require careful medical monitoring.

Resources

Arthritis Foundation. (nd). Types of drugs.

Arava.com. (updated 2005). Arava FAQs.

Duncan, M.A. (nd). The new drugs: Six doctors’ opinions.

Enbrel.com. (updated 2005). Enbrel in brief.

Matsumoto, A.K. (updated 2005). Rheumatoid arthritis treatments.

National Library of Medicine. (updated 2004). Rheumatoid arthritis. MedlinePlus Medical Encyclopedia.

Remicade-RA.com. (updated 2005). Remicade for RA.