Glucocorticoids

Common names are:

• Prednisone
• Prednisolone

These drugs are used if you have severe problems. They are given in short bursts that last one to two weeks. They lower over time. This is done so you don't have reactions. These doses are can help ease swelling. But they should not be used when the swelling is fighting off an infection. The longer you take them, the greater your risk of problems from them.

There are many health problems linked to these drugs. Before taking a dose, ask your doctor if you have any reasons not to take it. You may also need to take calcium, vitamin D, osteoporosis and blood pressure drugs while taking them. You will also need to watch your blood sugar levels.

Problems are:

• Fat face, hump on the lower neck
• Weight gain
• High blood pressure
• Risk of infection
• Bruising
• Acne
• Unusual hair growth
• Soft bones
• Bone death
• Eye problems
• Diabetes
• Muscle disease
• Hypokalemia
• Menstrual problems
• Irritability
• Problems sleeping
• Mental health problems

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)—higher doses

Common names are:

• Ibuprofen
• Naproxen
• Sulindac
• Diclofenac
• Piroxicam
• Ketoprofen
• Diflunisal
• Nabumetone
• Etodolac
• Oxaprozin
• Indomethacin
• Celecoxib

NSAIDs are used to treat mainly muscle and bone problems. They are likely safer for long term use than other drugs. But they can cause bad problems. Stay in touch with your doctor if you are on one of these drugs. You may not be able to take them if you have digestive issues.

Problems at high doses are:

• Stomach problems, including ulcers and bleeding
• Worsening of health problems like high blood pressure, heart failure, or kidney disease
• Kidney damage
• Liver inflammation
• Lightheadedness
• Severe allergic reaction, such as hives, problems breathing, or swelling around the eyes
• Greater risk of bleeding—tell your doctors or dentists that you are taking an NSAID before you have any procedures

NSAIDs may raise your risk of serious heart problems, like heart attack and stroke. Patients with heart disease or those who have risks for heart disease will need to be careful.

Take special care with NSAIDs and aspirin if you have had peptic ulcer disease ( gastric or duodenal ulcers, or gastritis).

Antimalarial Drugs

Common names are:

• Hydroxychloroquine sulfate
• Chloroquine

These drugs change the way the body reacts to swelling. They are used for mild problems.

Problems are:

• Headache
• Mood changes
• Lightheadedness
• Weakness
• Nausea
• Vomiting
• Diarrhea
• Belly cramps
• Lack of hunger
• Vision problems
• Rashes
• Blood damage
• Muscle weakness

Immune Modulators (Immunosuppressives)

Common names are:

• Methotrexate
• Cyclophosphamide
• Azathioprine
• Mycophenolate mofetil

Immune modulators lower the immune system and inflammation. These may be used when someone can't handle high doses of steroids. They may also help people who aren't helped by steroids. These drugs make it harder for the body to fight infection. You will need to watch cuts, scrapes, or any small wounds for signs of infection. You may also be at a higher risk for bacterial or viral infections.

Problems are:

• Bone marrow damage
• Increased frequency of cancer
• Hair loss
• Ovary damage
• Liver damage (azathioprine)
• Bladder damage (cyclophosphamide)

Targeted B-cell Therapy

Common names are:

• Belimumab
• Rituximab

Targeted B-cell therapy is for people who are getting other standard therapies. The drug, given by IV, may lower the number of abnormal B-cells thought to harm tissue. The reduced action of infection-fighting lymphocytes raises your risk of bacterial or viral infections.

Problems are:

• Nausea
• Diarrhea
• Fever
• Insomnia
• Depression
• Migraine
• Reactions during infusion, such as headache and nausea
• Rash or hives at infusion site
• Increased frequency of cancer

Nonsteroidal anti-inflammatory drugs (NSAIDs)—lower doses

Common names are:

• Aspirin
• Ibuprofen
• Naproxen

There are minor differences, such as dosing intervals and problems.

Problems from NSAIDs at low doses are:

• Stomach problems, including ulcers and bleeding
• Worsening of health problems, such as high blood pressure, heart failure, or kidney disease
• Kidney damage
• Liver inflammation
• Lightheadedness
• Severe allergic reaction, such as hives, problems breathing, or swelling around the eyes
• Increased risk of bleeding—tell your doctors that you are taking an NSAID before you have any medical or dental procedures

NSAIDs may raise your risk of serious heart problems, like heart attack and stroke. This risk is important for patients with heart disease or those who are have risk factors for heart disease.

Take special care with NSAIDs and aspirin if you have had peptic ulcer disease ( gastric or duodenal ulcers, or gastritis).

Anticoagulants and Anti-Thrombotics

Common names are:

• Aspirin (anti-thrombotic)
• Heparin
• Warfarin

Anticoagulants work by interfering with the clotting process. They are used in people with antiphospholipid antibody syndrome. This is an autoimmune disease that makes the blood clot easier. Blood clots can cause serious problems that can change the way blood flows all over the body. It also raises the risk of heart attack and ischemic stroke. Anticoagulant use needs to be watched to find the right balance. Too much can cause bleeding.

Problems are:

• Lower than normal number of platelets, which can raise blood clotting time
• Allergic reaction
• Hemorrhagic stroke
• Hair loss (warfarin)
• Bleeding in the eye (warfarin)
• Gastrointestinal bleeding or ulcers (aspirin)
• Ringing in the ear— tinnitus (aspirin)