Rheumatoid arthritis is a very painful condition and this is something that only those who suffer from it can understand. In this condition the joints get inflamed and the condition degenerates over time unless steps are taken to stop or slow down this degeneration.
Generally, once a person is diagnosed with rheumatoid arthritis he or she is prescribed a combination of drugs and physical therapy or other treatments.
What are the Medicines for Rheumatoid Arthritis?
Medicines for rheumatoid arthritis are basically of four types while the fifth is a variation of another drug. These can be broadly classified as analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids or corticosteroids and disease modifying anti-rheumatic drugs or DMARDs. The fifth type is the variation of DMARD and known as biologic response modifiers or Bio DMARDs.
Since drugs can have side effects, the doctors in the past were hesitant to use steroids or DMARDs. So the approach was to begin with analgesics and then move on to more potent drugs once analgesics did not give the desired effect. But this delayed the process of slowing the progress of rheumatoid arthritis.
But the concept has simply turned round and doctors these days start off with the potency required for the intensity of the condition rather than gradual increase in potency. This has proved very effective in managing the pain associated with rheumatoid arthritis. It has not only provided relief to the patient but also managed to lessen joint damage and increase mobility.
Drugs for Treatment of Rheumatoid Arthritis
Analgesics are the medicines that we generally refer to as painkillers. They are used for a variety of pain related treatments and also in case of rheumatoid arthritis. But these drugs can only give relief in pain and they are incapable of taking care of swelling. So they can be used only in mild cases of rheumatoid arthritis.
The commonest drug in this category is acetaminophen. There are not many side effects but it is better to avoid alcohol while on this drug. Paracetamol, Tramadol, Oxycodone, etc. fall into this category. There are some analgesics that actually fall under the category of narcotic drugs. So it is best to let the doctor know about your drug and alcohol habits. It is also advised that one should not stop or change the dosage without the doctor’s direction. These drugs may show some side effects like dizziness, constipation or nausea.
NSAIDs (Non-steroidal anti-inflammatory drug)
These drugs have the ability to both control pain as well as lessen any inflammation. They reduce inflammation by blocking the enzymes that cause such inflammations. Most of the time, combination of NSAIDs and other drugs are used for treatment of rheumatoid arthritis.
This is because they simply cannot reduce bone or joint damage. The word of caution for use of NSAIDs is that they should not be used for long time. Moreover, they are generally not prescribed to people having stomach ulcers or liver problems as this medicine can affect the digestive tract. Ibuprofen and diclofenac sodium are the commonest of such NSAIDs. Diarrhea, heart burn, indigestion, etc. are some of the common side effects of this drug and that is why NSAIDs are given in combination with antacids.
Glucocorticoids or Corticosteroids
These drugs are actually steroids and they are very useful in controlling pain and inflammation. In case of rheumatoid arthritis, they can even stop or slow down the damages caused to the joints. The problem with such drugs is that they should be used very carefully according to the physician’s direction.
Sudden increase or decrease in dose or stopping the drug can result in serious problems. The common corticosteroids are prednisone and betamethasone. Both are used very widely but have side effects like high blood pressure, muscle weakness, infections and even mood swings.
Disease Modifying Anti-Rheumatic Drug (DMARD)
As the name suggests these drugs are specifically designed to tackle the problem of rheumatoid arthritis. These are the more potent and effective drugs than the earlier ones. Instead of going around trying to reduce pain, the modern treatment aims are hitting at the root of the problem.
It interrupts the immune system which is responsible for the inflammation. This helps in slowing down or stopping the progression of rheumatoid arthritis. But to see their effect a patient may have to wait as long as six months. Though doctors sometimes prescribe these drugs along with corticosteroids or NSAIDs, these drugs alone are almost capable of tackling the condition.
While on these drugs, the patient must be careful about infections as the drug operates by weakening the immunity system. Along with it regular blood tests and check ups for monitoring the functioning of the organs like kidneys, liver and lungs should be done to ascertain that all is going well.
The common drugs falling into this group are methotrexate, leflunomide, hydroxychloroquine sulfateq, cyclosporine, azathiaprine, gold sodium thiomalate and oral gold or auranofin. All these drugs have their own set of side effects ranging from simple ones like diarrhea, nausea, loss of appetite to more complex ones like low blood count, blurred vision or abnormal hair growth. So any treatment with these drugs should be preceded by a thorough check up of the body condition of the patient as well as his or her medical history.
Biologic Response Modifiers or Bio-DMARDs
These drugs are another group of DMARDs which actually target only that part of the immune system which is responsible for conditions like joint pain and inflammation. Like all the other medicines they too cannot cure the condition but help relieve the symptoms and retard or stop the progress of the disease.
It has been seen that it is a long term treatment. Normally bio-DMARDs or biologic response modifiers are used together with another DMARD, methotrxate. Since these bio-response modifiers are administered through injections only, a treatment with them may be costly.
Some of the biological response modifiers are abatacept, anakinra, adalimumab,infliximab, etanarcept, golimumab, rituximab,tocilizumab and certolizumab pegol. All these bio-DMARDs may have serious side effects if they are not used under controlled conditions. So it is important that when on these drugs, keep in constant with the doctor and even consult him for simple ailments and all over-the-counter drugs. One of the main precautions for most of these drugs is that the patient must not be given any live vaccine while on treatment with these.