Medication for arthritis

Arthritis Care / 26 June 2017

The right drugs can reduce the pain and symptoms of arthritis, and some can slow its progress. But it's important to be informed about what may work for you.



For many people, it can be hard to accept that you need medication for your arthritis – particularly if this is in the long term. But it is important that you feel in control of the drugs you take and can discuss what is best for you with your GP or other health professionals. Understanding and being well informed about the types of medication available and how they work can help. It is also important to remember that any drug can have side effects. The benefits usually outweigh the negatives, but do talk about any treatment plan with your doctor.

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What is the most effective medication for arthritis?

Arthritis medication can be grouped into the four main types. Remember, what works for you will depend on the nature of your arthritis and your individual needs.

Painkillers (analgesics)

When we are ill or injured, our bodies’ healing processes produce chemicals that cause pain, inflammation and fever. Analgesics work by blocking the body's response to pain-causing chemicals. They're usually taken orally or can be given by injection. Slow-release painkilling patches are also available.

Painkillers come in varying strengths. Paracetamol is the simplest and safest, and is usually the best over-the-counter medicine to try first. It can ease pain and bring down a high temperature, but won't reduce inflammation.

Non-steroidal anti-inflammatory drugs (NSAIDs)

The most common drugs used to treat arthritis, NSAIDs reduce inflammation of the joints, and relieve pain and stiffness, so are particularly effective at treating rheumatoid arthritis.

They're usually taken orally, but are also available as creams, gels and suppositories. Commonly prescribed NSAIDs include diclofenac, ibuprofen, indometacin, nabumetone, naproxen and piroxicam.

Check with your GP before taking NSAIDs, particularly if you suffer from stomach problems. NSAIDs may irritate the stomach lining, causing an ulcer, so you may be prescribed an anti-ulcer drug, too.

Disease-modifying anti-rheumatic drugs (DMARDs) and biologic drugs

Conventional DMARDs are used to treat autoimmune conditions, such as rheumatoid arthritis and psoriatic arthritis. They work by calming the harmful immune response and preventing further damage.

They are taken orally or by injection – and can take several weeks to take effect. Commonly prescribed DMARDs include methotrexate, sulfasalazine and hydroxychloroquine.

Biologic drugs work by targeting specific cells and chemicals, and tend to take effect quicker than conventional DMARDs.

They include anti-TNFs, which suppress the action of the protein TNF. Over-production of this protein can cause inflammation and pain and anti-TNFs can be useful for people with severe rheumatoid arthritis or psoriatic arthritis. Common types are etanercept, infliximab and adalimumab.

Other biologic drugs – such as rituximab and abatacept – are available by infusion or injection for those who haven't responded to anti-TNF treatment.

All DMARDs and biologic drugs affect your immune system, so may make you more prone to infection.

Corticosteroids

These powerful drugs can reduce inflammation and control the body's response to inflammation.

To treat arthritis, they are taken via injection – either to target a specific area or to control a general flare-up – or as tablets. Common types include hydrocortisone, triamcinolone and prednisolone. Potential side effects including diabetes and osteoporosis.

Arthritis drugs in detail

Read on to discover more about some of the most commonly prescribed arthritis medication.

DMARDs

Methotrexate (Maxtrex)

Usually prescribed during the early stages of rheumatic conditions, including rheumatoid arthritis and psoriatic arthritis. It's taken weekly in tablet form and takes up to 12 weeks to become fully effective.

Methotrexate can, very occasionally, damage the bone marrow or liver so you'll initially need regular blood tests. It can also interact with some antibiotics. Other possible side effects include an itchy rash, sore mouth, vomiting and diarrhoea.

Sulfasalazine (Salazopyrin EN)

Reduces inflammation in joints and eases arthritis symptoms, such as pain, swelling and stiffness. Taken in tablet form, it has a special slow-dissolve coating, which helps reduce nausea and stomach problems.

You'll need monthly blood tests for the first three months, then every three months. The most common side effects include nausea and headaches. It may also turn your urine orange or dark yellow, and your tears may be discoloured – though this is nothing to worry about.

Azathioprine (Azamune or Imuran)

Used to treat rheumatic conditions, including rheumatoid arthritis and lupus. It's given in tablet form and can take around eight weeks to become effective. You may be prescribed azathioprine alongside a steroid treatment, as this may mean your steroid does can be reduced.

The most common side effects are nausea and loss of appetite. There may also be a slightly increased risk of developing certain types of cancer.

Ciclosporin (Neoral)

Effective in treating psoriatic arthritis and lupus and infrequently used to combat pain, swelling and inflammation in rheumatoid arthritis. Usually taken in capsule form, it may take up to four months before any benefit is noticed.

Possible side effects include high blood pressure and kidney problems, particularly with long-term treatment.

Cyclophosphamide

A powerful drug that works by suppressing bone marrow activity. It's given by injection into a vein and can take around six weeks to take effect.

Because cyclophosphamide affects the blood and bladder, you'll need blood and urine tests both before and during treatment. It can lead to permanent sterility in men and reduced fertility in women, and lowers immunity. There’s also a slightly increased risk of certain cancers.

Hydroxychloroquine (Plaquenil)

Prescribed to reduce inflammation and slow the progress of rheumatoid arthritis and lupus, this anti-malarial is among the mildest DMARDs. Taken daily in tablet form, it can take up to six months for the full benefits to be felt.

It can affect eyesight, so do have regular eye checks. Other rare side effects include indigestion, diarrhoea and headaches.

Gold by injection (sodium aurothiomalate)

One of the oldest drugs used to treat rheumatoid arthritis. Also prescribed for some cases of psoriatic arthritis and palindromic arthritis. It's initially taken by weekly injection in the buttock, and can take up to six months to become fully effective.

Possible side effects include dermatitis, bone marrow damage and kidney problems, so you'll need regular blood and urine tests.

Leflunomide (Arava)

Reduces the pain and inflammation of rheumatoid arthritis. Taken daily in tablet form, it can take up to six months before the full effects are felt. Regular blood and blood pressure tests are required.

You may be more prone to infection and liver damage. Other possible side effects include sickness, diarrhoea, mouth ulcers, weight loss and hair loss.

Biologic drugs

Adalimumab (Humira)

An anti-TNF drug used to treat conditions including rheumatoid arthritis and psoriatic arthritis. It's taken by injection under the skin every two weeks, and takes up to 12 weeks to become effective.

Possible side effects include redness or swelling and higher risk of infection.

Etanercept (Enbrel)

Another anti-TNF drug used to treat rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. It's taken by injection under the skin once or twice a week. Full benefits should be felt within two to 12 weeks. As with other anti-TNFs, it can increase risk of infection.

Infliximab (Remicade)

An anti-TNF used to treat rheumatoid arthritis and psoriatic arthritis. It's taken over several sessions by intravenous drip Full benefits should be felt within 12 weeks. Again, it can make you more prone to infection.

Certolizumab pegol (Cimzia)

An anti-TNF drug used to treat rheumatoid arthritis. As with other anti-TNFs, it’s only given to people who meet specific criteria. It's given as an injection beneath the skin of the thigh or stomach every two weeks. You should feel the benefits within 12 weeks. Side effects include increased risk of infection.

Corticosteroids

Prednisolone (Deltacortril)

A powerful anti-inflammatory used to treat rheumatoid arthritis, polymyalgia rheumatica, giant cell arteritis and other inflammatory conditions. Taken in tablet form, its effects should be felt within a few days.

Prednisolone can cause pre-existing diabetes to develop or worsen, so you'll need regular blood and urine tests. Long-term high-dose use can also increase risk of weight gain, high blood pressure and osteoporosis. Because of these side effects, the drug is only given to people with inflammatory conditions where major organs are involved, and where there is a possibility of vasculitis, or where other treatment isn’t working.

Remember, any drug can have side effects – so do discuss your medication plan thoroughly with your GP, and ask for regular reviews.

For more information, go to www.arthritiscare.org.uk/do-i-have-arthritis/publications/1422-medication-for-your-arthritis and download your free booklet, Medication for Your Arthritis.

For facts, support and guidance on all aspects of arthritis, call Arthritis Care's free Helpline on 0808 800 4050. They are open Monday to Friday, 09.30-17.00.

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