Rheumatoid Arthritis (RA) Medications

Rheumatoid arthritis(RA) is a disease in which the body'simmune systemattacks its own joints. This results in pain, swelling, and potentially permanent damage. RA should not be confused with osteoarthritis (OA) which is joint pain resulting from the wearing down ofcartilage– most commonly in the knees and hips. By contrast, RA commonly affects smaller joints, such as the fingers and toes.

Types of Rheumatoid arthritis medications

There are several different types of rheumatoid arthritis medications.

Analgesics

Analgesics, or painkillers, are a staple of RA treatment. Mild-to-moderate RA pain can usually be treated with non-opioidanalgesics. But for severe pain, opioids and opioid combinations are more effective. That increased effectiveness does come with the potential for side effects, including drowsiness and constipation.

Non-Opioid Medications

• Acetaminophen(Tylenol)
• Tramadol(Ultram)

Combination Products: Opioids plus Other Analgesics

• Acetaminophen withcodeine(Tylenol #3, Tylenol #4)
• Acetaminophen withhydrocodone(Hycet, Lortab,Norco,Vicodin,Vicodin ES,Vicodin HP,Xodol,Zamicet)
• Aspirin with dihydrocodeine andcaffeine(Synalgos-DC)
• Ibuprofen with hydrocodone (Ibudone,Reprexain,Vicoprofen)
• Acetaminophen withoxycodone(Percocet,Roxicet,Xartemis XR)
• Aspirin with oxycodone (Percodan)

Opioids (single ingredients)

• Fentanyl(Abstral,Actiq,Duragesic,Fentora,Lazanda,Onsolis,Subsys)
• Hydrocodone bitartrate (HyslingaER,Zohydro ER)
• Hydromorphone(Dilaudid, Dilaudid HP,Exalgo)
• Meperidine(Demerol)
• Methadone(Dolophine)
• Morphinesulfate (MS Contin,Kadian,Avinza)
• Oxycodone (Oxycontin,Oxecta)
• Oxymorphone(Opana,Opana ER)
• Tapentadol(Nucynta,Nucynta呃)

Opioid Agonists/Antagonists

• Buprenorphine(Butrans,Buprenex)
• Butorphanol(ButorphanolNS,Stadol)
• Nalbuphine
• Pentazocine (Talwin)

Anti-Inflammatory Medications

This class of drugs is also known as non-steroidal anti-inflammatory drugs (NSAIDs). They work by inhibiting and/or interfering with chemicals in the body which causes inflammation. The most common drawback toNSAIDuse is their propensity to cause stomach andgastrointestinalbleeding.

• Aspirin
• Celecoxib (Celebrex)
• Diclofenac
• 双氯芬酸/Misoprostol(Arthrotect)
• Diflunisal
• Etodolac
• Ibuprofen (Motrin, Advil)
• 吲哚美辛(Indocin)
• Ketoprofen
• Nabumetone
• Naproxen(Naprosyn, Anaprox, Aleve)
• Naproxen/Esomeprazole(Vimovo)
• Naproxen/Lansoprazole(Prevacid NapraPAC)
• Oxaprozin (Daypro)
• Piroxicam(Feldene)
• Salsalate
• Sulindac
• Tolmetin

Biologic Agents

Biological drugs are proteins manufactured usingrecombinant DNA technology. They are immunosuppressants that target and block the action of cells or chemicals that enable the immune system to cause inflammation and other symptoms of RA. Biological agents are called disease-modifying antirheumatic drugs (DMARDs) because by suppressing components of the immune system they reduce symptoms and reverse the course of RA.

• Abatacept(Orencia)
• Adalimumab(Humira)
• Anakinra(Kineret)
• Certolizumab (Cimzia)
• Etanercept(Enbrel)
• Golimumab(Simponi)
• Infliximab(Remicade)
• Rituximab(Rituxan)
• Tocilizumab(Actemra)

Janus Kinase (JAKs) Inhibitor

JAK inhibitors are the newest class of drugs used to treat RA. They work by blocking Janus kinase JAKs) enzymes located withinstem cellsand other cells. JAKs enzymes are involved in stimulating immune responses that contribute to symptoms of RA. Therefore, inhibiting JAKs enzymes reduces symptoms of RA.

Tofacitinib(Xeljanz) is an oral drug and is the first JAKs inhibitor approved by the FDA.

Corticosteroids

Corticosteroids are synthetic versions of anti-inflammatory chemicals normally produced in the body. They are powerful, but long-term use can result in severe side effects, including weaker bones and a depressed immune system.

• Cortisone
• Dexamethasone
• Hydrocortisone(Cortef)
• Ethamethasoneb (Celestone)
• Fludrocortisone(Florinef)
• Methylprednisolone(Medrol, Depo-Medrol, Solu-Medrol)
• Prednisone
• Prednisolone(Prelone)
• Triamcinolone(Aristospan, Kenalog)

Disease-Modifying Antirheumatic Drugs (DMARDs)

DMARDs don't just relieve pain and/or inflammation of RA, they actually can alter the course of thechronic disease, and help stop some of the damage from getting worse. DMARDs include the biological drugs listed above as well as non-biological drugs listed below.

• Methotrexate, a cancer drug, is one of the most popular and effective drugs in this class.
• Azathioprine(硫唑嘌呤)
• Auranofin (Ridaura)
• Chloroquine(Aralen)
• Cyclophosphamide(Cytoxan)
• Cyclosporine(Gengraf,Sandimmune)
• Gold sodium thiomalate (Myochrysine, Solganal)
• Hydroxychloroquine (Plaquenil)
• Leflunomide(Arava)
• Methotrexate (Rheumatrex)
• Minocycline(Minocin)
• Mycophenolate(CellCept)
• Penicillamine(Cuprimine)
• Sulfasalazine(Azulfidine)

Tofacitinib (Xeljanz) is the newest medication available for rheumatoid arthritis. Known as a JAKs inhibitor, tofacitinib works by inhibiting certain enzymes involved in the inflammatory process.

Most patients with Rheumatoid Arthritis (RA) will, at some point, use over-the-counter medications to control pain -- most commonly, acetaminophen (Tylenol). OtherOTCmedications which can help with RA pain and inflammation include aspirin and non-prescription versions of ibuprofen (Advil, Motrin) or naproxen (Aleve). In addition, some topical pain medications may also provide relief. These ointments and creams are generally divided into three categories:

Salicylates

Salicylates are derivatives of aspirin. In topical form, they are absorbed through the skin and exert a local, anti-inflammatory (and thus pain-relieving) effect.

• Aspercreme
• BenGay
• IcyHot
• Myoflex
• Salonpas
• Theragesic
• Trolamine

Capsaicin

Capsaicinboth stimulates and inhibits pain signals in the body.

• Capsazin
• Zostrix

女伯爵r-Irritants

女伯爵r-irritants work by creating a sensation in one location, to draw attention away from a source of pain in another.

• Mineral Ice

Here are the side effects of different types of rheumatoid arthritis medications.

Analgesics

• Acetaminophen may cause damage to the liver in excessive doses.
• Aspirin has the potential to cause stomach bleeding.
• Opioid analgesics may cause drowsiness, confusion, reducedrespiratory rate, constipation, and the potential for addiction.

Nonsteroidal Anti-Inflammatories

• Gastrointestinal irritation with possible bleeding
• Some may cause drowsiness (piroxicam)
• Kidney damage

Biologic Agents

• Irritation at the injection site
• Allergic reactions
• Increased susceptibility to infection

Corticosteroids (Long-term use)

• Weight gain
• Damage to bone and cartilage
• Thinning of skin
• Increasedblood glucoselevels
• Gastrointestinal irritation
• Cataracts
• Increased blood pressure

Disease-Modifying Antirheumatic Drugs

Azathioprine (Imuran)

• Potentially serious blood disorders
• Increased risk for some cancers

Auranofin (Ridaura)

• Potentially serious, even fatal, blood disorders
• Kidney problems
• Mouth sores
• Diarrhea

Chloroquine (Aralen), Hydroxychloroquine (Plaquenil)

• Vision problems
• Hearing problems
• Seizures
• Musculoskeletal issues, including weakness and lack of coordination

Cyclophosphamide (Cytoxan)

• Nausea
• Vomiting
• Hair loss
• Increased risk for developing shingles

Cyclosporine (Sandimmune)

• Increased risk for some cancers
• Increased risk for serious infections
• Kidney damage
• High blood pressure

Leflunomide (Arava)

• Diarrhea
• Stomach pain
• Rash
• Hair loss
• Liver injury
• Lung problems including coughing, shortness of breath, lung damage

Methotrexate (Rheumatrex)

• Nausea
• Vomiting
• Mouth sores
• Liver damage with long-term use
• Serious blood problems

Gastrointestinal side effects can be greatly diminished by taking afolic acidsupplement.

Minocycline (Minocin)

• Rectaland/or vaginal itching
• Diarrhea
• Changes in skin color including increased susceptibility to sunburn
• Hearing loss ortinnitus(ringing in the ears)
• Black discoloration of the tongue

Mycophenolate (CellCept)

• Damage to the fetus in pregnant women

Penicillamine (Cuprimine)

• Kidney damage
• Serious, even fatal, blood disorders
• Liver abnormalities
• Pemphigus
• Allergic reactions

Sulfasalazine (Azulfidine)

• Nausea
• Abdominal pain
• Increased susceptibility to sunburn
• Orange-colored urine and/or skin
• Possible changes in blood cell count

RA Drugs That Can Cause Weight Gain

• Corticosteroids

RA Drugs That Are Preferred during Pregnancy

• Sulfasalazine (Azulfidine)
• Chloroquine (Aralen)
• Hydroxychloroquine (Plaquenil)
• Corticosteroids
• Nonsteroidal Anti-Inflammatories (Until 32 weeks)
• Cyclosporin
• Azathioprine
• Anti-TNFBiologic Agents

RA Drugs That Are Not Recommended during Pregnancy

• Methotrexate (Rheumatrex)
• Mycophenolate (CellCept)
• Cyclophosphamide (Cytoxan)
• Rituximab (Rituxan)

RA Drugs with the Least Side Effects

Taken at the proper dose, acetaminophen carries the lowest risk for side effects. However, exceeding the recommended dose can result in severe, even fatal, liver damage.

A few natural remedies may help patients with rheumatoid arthritis.

• Omega-3-fatty acids, found infish oilcapsules, may reduce inflammation.
• The same would be true for gamma-linoleic acid. Herbal preparations with possible benefits includeginger, Devil's claw, and white willow.

Biologic agents used to treat RA need to be injected. The biggest benefit of these drugs is that they are very effective.

• Biologics not only relieve symptoms but also halt damage to joints and generally provide quick relief.
• The biggest drawback of biological agents is cost. Patients can spend thousands of dollars a month using biologics.
• Other drawbacks include side effects, which may be severe because biologics suppress the immune system, enhancing the possibility of infections.
• In addition, patients may not like receiving injections.

Most of the medications used for rheumatoid arthritis provide relief from pain. However, depending on current disease activity, some may be more effective than others.

• For acute flare-ups, for example, short-term treatment with acorticosteroid, such as prednisone, may be highly beneficial.
• If there is excessive inflammation, a non-steroidal anti-inflammatory can address that symptom and also relieve pain.
• Over-the-counter analgesics, such as acetaminophen, may be used for minor pain.
• But for chronic, moderate-to-severe pain, an opioidanalgesicwould be more effective.
• Pain and inflammation are both addressed by biological drugs which have the added benefit of altering disease activity.

Rheumatoid arthritis treatment is an active area of research. In fact, according to the Pharmaceutical Research and Manufacturers of America, more than 50 drugs for rheumatoid arthritis are in various stages of clinical testing.

• Many of these are new biologics.
• Others targethistaminereceptors andglucocorticoidreceptors.

Fortunately, if one RA drug is not working, there are others to switch to – and this commonly happens. Also, combinations of drugs sometimes work better than one drug alone.

To complement drug therapy, doctors recommend that patients with RA should engage in a regular exercise program to help strengthen joints and maintain flexibility.Physical therapycan also help develop a betterrange of motionin affected joints. The use of heat and/or cold can provide pain relief and loosen stiff joints. Massage, acupuncture, and rest may be useful in alleviating RA symptoms.