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Medications for Rheumatoid Arthritis

The information provided here is a general summary about each of the medicines listed below. Only the most general side effects are included. Ask your doctor if you need to take any special steps for your care plan. Use each of these medicines only as recommended by your doctor. Follow the instructions that are given to you. If you have questions about usage or side effects, contact your doctor.

There are a variety of medicines available to treat pain and inflammation. They are often used in combination. This may increase benefits, but can also increase side-effects.

Rheumatoid arthritis (RA) process is different in everyone. It may take some time to find the right combination of medicine for you with the lowest number of side effects.

Prescription Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs)

  • Naproxen
  • Ketoprofen
  • Ibuprofen
  • Indomethacin
  • Sulindac
  • Meclofenamate
  • Ketorolac
  • Piroxicam
  • Diclofenac sodium

Cyclooxygenase-2 or COX-2 inhibitors

  • Celecoxib
  • Meloxicam

Nonbiologic disease-modifying antirheumatic drugs (DMARDs)

  • Azathioprine
  • Cyclophosphamide
  • Cyclosporin
  • D-penicillamine
  • Hydroxychloroquine sulfate
  • Leflunomide
  • Methotrexate
  • Sulfasalazine

Biologic disease-modifying antirheumatic drugs (DMARDs)

  • tumor necrosis factor (TNF)-inhibitors
  • Interleukin-1 receptor blockers
  • Biologic response modifier and disease-modifying antirheumatic drug
  • Monoclonal antibody
  • Interleukin-6 receptor antagonist

Corticosteroids

  • Prednisone
  • Methylprednisolone

Over-the-counter Medications

Prescription Medications

 

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Common names include:

  • Naproxen
  • Ketoprofen
  • Ibuprofen
  • Indomethacin
  • Sulindac
  • Meclofenamate
  • Ketorolac
  • Piroxicam
  • Diclofenac sodium

Although some NSAIDs are available as over-the-counter medications, you may still be given a prescription in order to obtain a higher dosage. NSAIDs help decrease inflammation, swelling, and joint pain.

Be sure to take NSAIDs with food to decrease the chance of stomach irritation.

Drinking alcoholic beverages or taking other NSAIDs, COX-2 inhibitors, aspirin, or steroids while you are already using an NSAID can increase your risk of side effects.

Possible side effects include:

  • Stomach upset
  • Stomach ulcers
  • Kidney damage
  • Liver inflammation
  • Confusion or lightheadedness
  • Severe allergic reaction, such as hives, difficulty breathing, or swelling around the eyes
  • Increased risk of bleeding—always inform your doctors that you’re taking an NSAID before having any medical or dental procedures or surgeries
  • Asthma
  • Possible increased risk of heart attack
 

Cyclooxygenase-2 or COX-2 Inhibitors

Common names include:

  • Celecoxib
  • Meloxicam

COX-2 inhibitors work in a way similar to NSAIDs, helping to decrease inflammation, swelling, and joint pain. The way the medicines do this allows them to work without causing the same degree of stomach irritation. In particular, COX-2 inhibitors cause fewer stomach ulcers than NSAIDs do. There is an increased risk of heart attacks and strokes associated with these medicines. Doctors generally reserve them for use in people who can't take traditional NSAIDs and who have no risk factors for heart disease.

Drinking alcoholic beverages or taking NSAIDs, aspirin, or steroids while you are using a COX-2 inhibitor can increase your risk of side effects.

Possible side effects include:

  • Stomach upset
  • Stomach ulcers
  • Liver inflammation
  • Confusion
  • Severe allergic reaction, such as hives, difficulty breathing, or swelling around the eyes
  • Kidney disease
  • Heart failure
  • Asthma
  • Increased risk of bleeding—always inform your doctors that you’re taking a COX-2 Inhibitor before having any medical or dental procedures or surgeries
 

Disease-Modifying Antirheumatic Drugs (DMARDs)

Common names include:

  • D-penicillamine
  • Hydroxychloroquine sulfate
  • Methotrexate
  • Cyclophosphamide
  • Cyclosporine
  • Azathioprine
  • Leflunomide

These drugs are given in an effort to slow or halt the progression of RA. They are all immunosuppressive agents. Because RA is believed to be caused by an overactive immune system, it is hoped that calming the immune system’s activity will slow the progression of the disease.

Possible side effects include:

  • Nausea
  • Diarrhea
  • Liver inflammation
  • Bladder inflammation
  • Kidney damage
  • Nerve damage
  • High blood pressure
  • Infections
  • Lung inflammation
  • Muscle and nerve inflammation
 

Corticosteroids

Common names include:

  • Prednisone
  • Methylprednisolone

Corticosteroids are very potent anti-inflammatory agents and are given to reduce swelling, inflammation, and joint pain.

Possible side effects for short-term use (about 3 weeks or less) include:

  • Difficulty sleeping
  • Increased appetite
  • Mood swings, increased emotionality
  • Increases in blood pressure
  • Increased blood sugar (especially in people with diabetes)

Possible side effects for long-term use (about 3 weeks or longer) include:

 

Biologic Response Modifiers

Common names include:

  • Tumor necrosis factor (TNF)-inhibitors, such as:
    • Etanercept—restricted in the US
    • Infliximab
    • Adalimumab
    • Golimumab
    • Certolizumab
  • Interleukin-1 receptor inhibitors—anakinra
  • Biologic response modifier and disease-modifying antirheumatic drug (DMARD)—abatacept
  • Monoclonal antibody—rituximab
  • Interleukin-6 receptor antagonist—tocilizumab

These medicines are given when other drugs haven’t worked. Etanercept, adalimumab, and anakinra are given by injection. Infliximab, orencia, and rituximab are given by IV. They can help decrease the symptoms of RA by reducing certain inflammatory proteins that cause them. They may also increase your risk of contracting infections. You need to inform your healthcare provider that you are taking these medicines before you get any immunizations. Also TNF-inhibitors can increase the risk of Hodgkin and non-Hodgkin lymphoma, and other types of cancer in children and adolescents.

Before you start taking any of these medications, you will need a tuberculosis (TB) test to make sure you don't have a hidden case of tuberculosis. You will need to have your heart monitored while you take this medication. Contact your healthcare provider immediately if you develop any of the following symptoms after receiving one of these medications:

  • Chest pain
  • Difficulty breathing
  • Fever and chills
  • Productive cough
  • Itching
  • Hives
  • Flushed face
  • Rashes
  • Confusion
  • Weakness
  • Injection site reactions

Over-the-counter Medications

 

Acetaminophen

Acetaminophen can be helpful in relieving some of the pain associated with RA. Do not take a larger dose than is recommended. Don't drink alcoholic beverages while you are taking acetaminophen.

 

Capsaicin Cream

Common brand name: Zostrix

Capsaicin cream is rubbed on the skin of an affected joint to relieve the pain and inflammation of RA.

It is made using the active ingredient of hot chili peppers. Some people prefer to wear rubber gloves while applying the cream. If you do not, be sure to wash your hands very thoroughly with soap and water after using the cream. Be very careful not to get the cream near your eyes, as it will burn and sting. If you do get some in your eyes, flush them thoroughly with cool water.

Possible side effects include burning, stinging, or warm sensation when first applied to the skin.

Special Considerations

If you are taking medicine, follow these general guidelines:

  • Take the medicine as directed. Do not change the amount or the schedule.
  • Ask what side effects could occur. Report them to your doctor.
  • Talk to your doctor before you stop taking any prescription medicine.
  • Do not share your prescription medicine.
  • Medicines can be dangerous when mixed. Talk to your doctor or pharmacist if you are taking more than one medicine, including over-the-counter products and supplements.
  • Plan ahead for refills as needed.
REFERENCES:

Biologic disease-modifying antirheumatic drugs (DMARDs) for rheumatoid arthritis. EBSCO DynaMed website. Available at:http://www.dynamed.com/topics/dmp~AN~T566758/Biologic-disease-modifying-antirheumatic-drugs-DMARDs-for-rheumatoid-arthritis. Updated June 14, 2019. Accessed June 13, 2019.

Combination therapies for rheumatoid arthritis. EBSCO DynaMed website. Available at:http://www.dynamed.com/topics/dmp~AN~T114387/Combination-therapies-for-rheumatoid-arthritis. Updated March 26, 2019. Accessed June 13, 2019.

Corticosteroids for rheumatoid arthritis. EBSCO DynaMed website. Available at:http://www.dynamed.com/topics/dmp~AN~T115025/Corticosteroids-for-rheumatoid-arthritis. Updated June 4, 2019. Accessed June 13, 2019.

NSAIDs for rheumatoid arthritis. EBSCO DynaMed website. Available at:http://www.dynamed.com/topics/dmp~AN~T114579/NSAIDs-for-rheumatoid-arthritis. Updated November 23, 2016. Accessed June 13, 2019.

Nonbiologic disease-modifying antirheumatic drugs (DMARDs) for rheumatoid arthritis. EBSCO DynaMed website. Available at:http://www.dynamed.com/topics/dmp~AN~T115001/Nonbiologic-disease-modifying-antirheumatic-drugs-DMARDs-for-rheumatoid-arthritis. Updated June 6, 2019. Accessed June 13, 2019.

Rheumatoid arthritis. Arthritis Foundation website. Available at: http://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis. Accessed June 13, 2019.

Last reviewed November 2018 by EBSCO Medical Review Board  Last Updated: 10/16/2019