Rheumatoid Arthritis
 

Drug Table

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Medications Uses/Effects Side Effects
Analgesics and Nonsteroidal Anti-inflammatory Drugs (NSAIDs) Analgesics relieve pain; NSAIDs are a large class of medications useful against pain and inflammation. A number of NSAIDs are available over the counter. More than a dozen others—including a subclass called COX-2 inhibitors—are available only with a prescription. NSAIDs can cause stomach irritation or, less often, can affect kidney function. The longer a person uses NSAIDs, the more likely he or she is to have side effects, ranging from mild to serious. Many other drugs cannot be taken when a patient is being treated with NSAIDs because they alter the way the body uses or eliminates these other drugs. NSAIDs sometimes are associated with serious gastrointestinal problems, including ulcers, bleeding, and perforation of the stomach or intestine. People over age 65 and those with any history of ulcers or gastrointestinal bleeding should use NSAIDs with caution.
Acetaminophen Nonprescription medications used to relieve pain. Examples are aspirin-free Anacin*, Excedrin caplets, Panadol, Tylenol, and Tylenol Arthritis. Usually no side effects when taken as directed.
Aspirin Aspirin is used to reduce pain, swelling, and inflammation, allowing patients to move more easily and carry out normal activities. It is generally part of early and ongoing therapy. Upset stomach; tendency to bruise easily; ulcers, pain, or discomfort; diarrhea; headache; heartburn or indigestion; nausea or vomiting.
Traditional NSAIDs NSAIDs help relieve pain within hours of admin-istration in dosages available over-the-counter (available for all three medications). They relieve pain and inflammation in dosages available in prescription form (ibu-profen and ketoprofen). It may take several days to reduce inflammation. For all traditional NSAIDs: Abdominal or stomach cramps, pain, or discomfort; diarrhea; dizziness; drowsiness or light-headedness; headache; heartburn or indigestion; peptic ulcers; nausea or vomiting; possible kidney and liver damage (rare).
Corticosteroids These are steroids given by mouth or injection. They are used to relieve inflammation and reduce swelling, redness, itching, and allergic reactions. Increased appetite, indigestion, nervousness, or restlessness.
Methylprednisolone These steroids are available in pill form or as an injection into a joint. Improvements are seen in several hours up to 24 hours after administration. There is potential for serious side effects, especially at high doses. They are used for severe flares and when the disease does not respond to NSAIDs and DMARDs. Osteoporosis, mood changes, fragile skin, easy bruising, fluid retention, weight gain, muscle weakness, onset or worsening of diabetes, cataracts, increased risk of infection, hyper-tension (high blood pressure).
Prednisone
Disease-modifying antirheumatic drugs (DMARDs) These are common arthritis medications. They relieve painful, swollen joints and slow joint damage, and several DMARDs may be used over the disease course. They take a few weeks or months to have an effect, and may produce significant improvements for many patients. Exactly how they work is still unknown. Side effects vary with each medicine. DMARDs may increase risk of infection, hair loss, and kidney or liver damage.
Azathioprine This drug was first used in higher doses in cancer chemotherapy and organ transplantation. It is used in patients who have not responded to other drugs, and in combination therapy. Cough or hoarseness, fever or chills, loss of appetite, lower back or side pain, nausea or vomiting, painful or difficult urination, unusual tiredness or weakness.
Cyclosporine This medication was first used in organ transplantation to prevent rejection. It is used in patients who have not responded to other drugs. Bleeding, tender, or enlarged gums; high blood pressure; increase in hair growth; kidney problems; trembling and shaking of hands.
Hydroxychloroquine It may take several months to notice the benefits of this drug, which include reducing the signs and symptoms of rheumatoid arthritis. Diarrhea, eye problems (rare), headache, loss of appetite, nausea or vomiting, stomach cramps or pain.
Gold sodium thiomalate This was one of the first DMARDs used to treat rheumatoid arthritis. Redness or soreness of tongue; swelling or bleeding gums; skin rash or itching; ulcers or sores on lips, mouth, or throat; irritation on tongue. Joint pain may occur for one or two days after injection.
Leflunomide This drug reduces signs and symptoms and slows structural damage to joints caused by arthritis. Bloody or cloudy urine; congestion in chest; cough; diarrhea; difficult, burning, or painful urination or breathing; fever; hair loss; headache; heartburn; loss of appetite; nausea and/or vomiting; skin rash; stomach pain; sneezing; and sore throat.
Methotrexate This drug can be taken by mouth or by injection and results in rapid improvement (it usually takes 3-6 weeks to begin working). It appears to be very effective, especially in combination with infliximab or etanercept. In general, it produces more favorable long-term responses compared with other DMARDs such as sulfasalazine, gold sodium thiomalate, and hydroxychloroquine. Abdominal discomfort, chest pain, chills, nausea, mouth sores, painful urination, sore throat, unusual tiredness or weakness.
Sulfasalazine This drug works to reduce the signs and symptoms of rheumatoid arthritis by suppressing the immune system. Abdominal pain, aching joints, diarrhea, headache, sensitivity to sunlight, loss of appetite, nausea or vomiting, skin rash.
Biologic Response Modifiers These drugs selectively block parts of the immune system called cytokines. Cytokines play a role in inflammation. Long-term efficacy and safety are uncertain. Increased risk of infection, especially tuberculosis. Increased risk of pneumonia, and listeriosis (a foodborne illness caused by the bacterium Listeria monocytogenes).
Tumor Necrosis Factor Inhibitors These medications are highly effective for treating patients with an inadequate response to DMARDs. They may be prescribed in combination with some DMARDs, particularly methotrexate. Etanercept requires subcutaneous (beneath the skin) injections two times per week. Infliximab is taken intravenously (IV) during a 2-hour procedure. It is administered with methotrexate. Adalimumab requires injections every 2 weeks. Long-term efficacy and safety are uncertain. Etanercept: Pain or burning in throat; redness, itching, pain, and/or swelling at injection site; runny or stuffy nose.
     Etanercept Infliximab: Abdominal pain, cough, dizziness, fainting, headache, muscle pain, runny nose, shortness of breath, sore throat, vomiting, wheezing.
     Infliximab Adalimumab: Redness, rash, swelling, itching, bruising, sinus infection, headache, nausea.
     Adalimumab  
Interleukin1 Inhibitor This medication requires daily injections. Long-term efficacy and safety are uncertain. Redness, swelling, bruising, or pain at the site of injection; head-ache; upset stomach; diarrhea; runny nose; and stomach pain.
     Anakinra

 

Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases - www.niams.nih.gov
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