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There are several different treatments for arthritis, a disease that is characterized by the inflammation of joints. This article outlines the eight most common medications that are prescribed to patients with arthritis.

Arthritis, a type of disease that is characterized by inflammation of joints, is a common disease with more than a 100 different subtypes. Currently, there is no cure for arthritis. However, there are several medications that can help treat arthritis. These are the eight most common medications for the treatment of arthritis.

1. Disease modifying anti-rheumatic drugs (DMARDs)

DMARDs are a type of medication that is designed to help reduce levels of inflammation. Unlike other types of drugs that can help temporarily ease pain and inflammation, DMARDs work by slowing down progression of the disease. Hence, you will experience fewer symptoms and less damage over time. Some DMARDs are more common than others. The most common ones include:

  • Hydroxychloroquine
  • Leflunomide
  • Methotrexate
  • Sulfasalazine
  • Minocycline​

2. Biologics

Biologics are injectable drugs that work by blocking pathways that cause inflammation in our body. Arthritis develops because the immune system, which is normally designed to attack foreign pathogens, goes haywire and starts to attack our own healthy tissue instead. Hence, biologics try to target pathways that are involved in this autoimmune response. One of the common biologics includes TNF-alpha inhibitors, which reduce symptoms in the body and slows down progression of the disease. TNF-inhibitors specifically target an inflammatory molecule known as TNF-alpha, which helps reduce inflammation and helps protects joints. Unfortunately, biologics are not recommended for everyone as they increase the risk of infections. Therefore, they are not recommended for people that are immunocompromised.  

These are some of the common biologics:

  • Abatacept
  • Rituximab
  • Tocilizumab
  • Anakinra
  • Adalimumab
  • Etanercept
  • Infliximab
  • Certolizumab pegol
  • Golimumab​

3. Janus associated kinase (JAK) inhibitors

JAK inhibitors are not commonly prescribed, but your doctor may prescribe these if you are not a candidate for DMARDs or biologics or if you are non-responsive to treatment with these drugs. Similar to biologics, JAK inhibitors tend to modify the immune system and inflammatory pathways that can help reduce the activity of the immune system. JAK inhibitors help reduce inflammation and stop damage to tissues. JAK inhibitors include tofacitinib and baricitinib. While baricitinib is a new drug that is still being tested, several studies have suggested that it holds promise for patients that don’t respond to DMARDs. The most common side effects of using JAK inhibitors include headache, upper respiratory infections and diarrhea.

4. Non-steroidal inflammatory drugs (NSAIDs) and analgesics

NSAIDs are a type of medication that help reduce pain and inflammation. These are non-specific for arthritis and therefore, are used for a variety of different diseases. These include common over-the-counter NSAIDs including ibuprofen (Advil) and naproxen (Aleve). While NSAIDs can help ease inflammation and pain and are generally safe for long-term use, there are some side effects that can be very harmful. In particular, some people with NSAIDs can experience stomach bleeding and kidney damage if they take high doses of NSAIDs for a long period of time.

Analgesics are similar to NSAIDs as they also work as pain relievers. The most common analgesic includes acetaminophen (Tylenol). Particularly in arthritis, acetaminophen is widely used for relieving pain. In fact, some doctors prescribe acetaminophen as the first line of defense against osteoarthritis, which is one of the most common subtypes of arthritis. Acetaminophen appears to work best when it is taken before the pain and prevents pain that is associated in patients with high arthritis disease activity. Analgesics are safe drugs that don’t cause significant liver damage as long as you only take the recommended dosage.

5. Prescription NSAIDs

Similar to over-the-counter NSAIDs, prescription NSAIDs are pain-relieving agents and include naproxen, indomethacin, and a type of drug known as COX-2 inhibitors such as celecoxib. Therefore, prescription NSAIDs can help improve control of inflammation, pain and other arthritis symptoms associated with arthritis. However, similar to over-the-counter NSAIDs, prescription NSAIDs also carry a risk of heart attack and stroke. Other side effects associated with the use of prescription NSAIDs include stomach irritation, ulcers, stomach bleeding and kidney damage.

In very rare cases, side effects can be fatal. Likely, if you are using prescription NSAIDs for a long time, your doctor will continuously monitor your kidney function.

6. Corticosteroids

Corticosteroids are prescription medications that include the commonly used prednisone and cortisone, which are either taken orally or injected into the joints. These are often given alongside other therapies such as NSAIDs and DMARDs, and help control inflammation.

7. Prescription pain relievers

Pain relievers are vital for treatment of arthritis as joint pain is a significant component of the disease. Therefore, easing pain is essential for treatment of the disease. Unfortunately, long-term treatment using pain relievers can cause significant side effects and a higher sensitivity to pain. It is also important to keep in mind that while these medications can help ease pain, they don’t stop inflammation.

8. Topical creams and ointments

Topical NSAIDs, which involve rubbing creams, gels and ointments, can help relieve pain. These are rubbed in to the skin over an aching joint. Therefore, they represent another pain-relieving option. Additionally, using topical creams and ointments can bypass the major side effects people experience by taking oral NSAIDs.

  • Smolen, Josef S., et al. "EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs." Annals of the rheumatic diseases 69.6 (2010): 964-975.
  • Ramiro, Sofia, et al. "Safety of synthetic and biological DMARDs: a systematic literature review informing the 2013 update of the EULAR recommendations for management of rheumatoid arthritis." Annals of the rheumatic diseases 73.3 (2014): 529-535.
  • Zink, Angela, et al. "Treatment continuation in patients receiving biological agents or conventional DMARD therapy." Annals of the rheumatic diseases 64.9 (2005): 1274-1279.
  • Curtis, Jeffrey R., and Jasvinder A. Singh. "Use of biologics in rheumatoid arthritis: current and emerging paradigms of care." Clinical therapeutics 33.6 (2011): 679-707.
  • Photo courtesy of SteadyHealth

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