Medication used to treat rheumatoid arthritis

Ask about your medicines for Rheumatoid Arthritis
Information to help you understand and benefit from your medication

People living with rheumatoid arthritis are usually treated with a combination of drugs depending on
the severity of the disease and symptoms.
It is important for us to understand the different roles of each drug, which vary from
simply relieving pain to reducing inflammation or damping down the disease activity itself.

You should follow exactly the prescription guidelines on dosage and timing.

This leaflet tells you about the main groups of drugs used for treating RA. You may also be
prescribed steroid tablets or injections and/or other drugs for conditions related to your
rheumatoid arthritis. For more information on these please see the web sites listed later.


What are Non–Steroidal Anti- Inflammatory Drugs (NSAIDS)?
NSAIDs are usually tablets but can also be in suppository form or topical gel. They work by blocking prostaglandins, a hormone like substances that contribute to pain and inflammation. They reduce joint swelling and stiffness as well as providing pain relief.
They should be taken as directed by your doctor; some are once daily, twice a day or four
times a day. They can be taken with your other RA medicine.

They fall into two categories:

a) Traditional NSAIDs
examples include: diclofenac (Voltarol), naproxen (Naprosyn), ibuprofen (Brufen) Taken over a long period of time they can cause stomach problems and other side effects. You can help reduce the risk of these problems by: • Making sure you take your tablets with or after food • Asking your doctor about taking a tablet to protect your stomach e.g. omeprazole
b) The newer COX – 2 Inhibitors
examples include: celecoxib (Celebrex), etoricoxib (Arcoxia).
These are designed to be safer for the stomach.
There have been some recent concerns regarding NSAIDs and the COX 2 inhibitors and the possible increased risk of cardiovascular problems, especially for those people with a history of stroke or heart disease. You are advised to discuss with your doctor whether this type of drug is suitable for you.
NSAIDs are effective in helping to manage the symptoms of RA but do not work on the
underlying disease process therefore inflammation will still occur.
_________________________________________________________________________
National Rheumatoid Arthritis Society: registered charity no.1086976
Tel: 01628 823524 Helpline: 0845 458 3969 enquiries@rheumatoid.org.uk

What are Disease Modifying Anti-Rheumatic Drugs (DMARDS)?

DMARDs work on the immune system to reduce the occurrence of inflammation and slow down the
progression of the disease and to reduce the amount of damage to the joints. They should be
prescribed as early as possible after diagnosis to achieve the best long-term outcomes.
Drugs in this category include sulfasalazine, penicillamine, methotrexate, leflunomide, gold , hydroxychloroquine. ciclosporin. They can be taken individually or in combination. This group of drugs take time to be effective, up to 8-12 weeks before you may begin to feel better. Prior to commencing treatment you should be given information on the drug which will tell you about any potentially serious side effects and instructions for safety monitoring to protect you.
DMARDs are taken in various regimes e.g. once a week, every day or four times a day. Some are taken
by tablet and some given by injection.
Check carefully the dose and instructions given by your doctor and follow the monitoring
procedure.

What are Biologic Therapies ?

Biologic therapies, like DMARDs, slow down disease progression. They are used for people with RA in
whom traditional DMARD therapies have not worked. Strict guidelines are followed in assessing who is
eligible for this medication. Your Rheumatologist will advise you if this treatment is suitable for you. In
many cases, they are used together with a DMARD such as methotrexate. The biologic therapies work in different ways but simply they all inhibit proteins called cytokines, which contribute to inflammation. Examples are: infliximab (Remicade), adalimumab (Humira), etanercept (Enbrel), anakinra (Kineret), rituximab (Mabthera). Some are administered via an infusion in hospital others are given via injection either by yourself or a carer.
This group of drugs also have potential side effects and require safety monitoring. Information
and instructions for this will be given to you when you commence the therapy.


What are Analgesics?

Analgesics, more commonly known as painkil ers, are used to provide pain relief. Although they can
stop pain for some people, they usual y are more effective in reducing rather than eliminating pain
completely.
They come in different strengths – some can be bought over the counter and other stronger ones must
be prescribed. You can get tablets, liquid, patches and injections. Examples are: paracetamol,
co-codamol, tramadol.
Always check the dose and the instructions for taking the painkillers, never take more than
recommended, although you can take less if your pain is not as severe.

Some analgesics can cause dizziness, nausea and constipation but usually there are very few side
effects with this medicine.
You can take your painkillers along with your other RA medication but if you are taking medicine for
another condition you should check with your doctor or pharmacist that they do mix.
For further information on medicines used to treat RA please see www.rheumatoid.org.uk
www.arc.org.uk or ask your rheumatologist or nurse. R/AAMW/10/06

Source: http://nras.org.uk/includes/documents/cm_docs/2009/a/ask_about_your_medicines_for_ra.pdf