How is rheumatoid arthritis treated by prescription?
There are several prescriptions used to treat rheumatoid arthritis. There are different classes of rheumatoid arthritis prescriptions including NSAIDs, corticosteroids, DMARDs, immunosuppressants, and BRMs. Rheumatoid arthritis itself is a chronic, inflammatory disease that causes painful swelling, redness, and stiffness of the joints. The distinguishing feature of rheumatoid arthritis is symmetric joint inflammation. The joints on both sides of the body become inflamed (such as both wrists or both knees). The symmetric nature of the inflammation is one of the factors doctors use to differentiate rheumatoid arthritis from the other forms of arthritis.
This type of arthritis is an autoimmune disease, meaning the body's immune system attacks its own tissues - the joints in the case of rheumatoid arthritis. It's unclear what initiates this inflammatory process. Analgesic drugs relieve pain only and may cause gastrointestinal problems over time. Examples include acetaminophen (Tylenol®) and morphine.
Nonsteroidal anti-inflammatory drugs (NSAIDs) relieve pain and control inflammation. They do not slow the progression of the disease and the symptoms return when the drugs are discontinued. Traditional NSAIDs are available over the counter and stronger doses are available in prescription form. Examples include aspirin, ibuprofen, (Motrin®, Advil®), ketoprofen, naproxen (Naprosyn, Aleve®), and indomethacin (Indocin®). COX-2 Inhibitor NSAIDs are available in prescription form and have a reduced risk of gastrointestinal problems compared to traditional NSAIDs. Example includes celecoxib (Celebrex®).
Corticosteroids relieve inflammation and slow the related bone damage. Over time corticosteroids become less effective and can cause serious side effects. Examples include prednisone and methylprednisolone (Medrol®).
Disease-modifying anti-rheumatic drugs (DMARDs) work in combination with NSAIDs and/or corticosteroids to reduce pain, joint inflammation and damage, and improve joint function and stability. DMARDs are now recommended during the early stages of rheumatoid arthritis to slow or even prevent joint damage. Combination therapy attempts to lower the risk of side effects by combining different DMARDs in lower doses than are normally given for the individual drugs. Examples include methotrexate, hydroxychloroquine (Plaquenil®), oral gold or auranofin (Ridaura®), injectable gold or gold sodium thiomalate (Myochrysine®), chlorambucil (Leukeran®), sulfasalazine (Azulfidine®), minocycline (Minocin®), and penicillamine (Cuprimine®, Depen®). DMARDs have the potential of causing serious toxicity.
Immunosuppressants are a category of DMARDs that suppress the body's immune system, which is overactive in people who have rheumatoid arthritis. Examples include azathioprine (Imuran®), leflunomide (Arava®), cyclosporine (Neoral®, Sandimmune®), and cyclophosphamide (Cytoxan®).
In 2006 the FDA approved a new indication for rituximab (Rituxan®) for use in combination with methotrexate to reduce the signs and symptoms in adult patients with moderately-to-severely active rheumatoid arthritis.
Biological response modifiers (BRMs) selectively block cytokines, a cell protein involved in the inflammatory process. The long-term usefulness and safety of these drugs is unknown. Tumor necrosis factor (TNF) blockers are very effective BMRs for patients who don't respond well to DMARDs and are sometimes prescribed in combination with some DMARDs, such as methotrexate.