Medication is the primary form of treatment for rheumatoid arthritis (RA), an inflammatory condition of the joints.
Some drugs focus on merely treating symptoms, temporarily reducing the pain and inflammation of RA. But others, called disease-modifying anti-rheumatic drugs, or DMARDs, are able to change or slow the progression of the disease, helping to prevent severe joint damage and other complications from developing.
Medication for rheumatoid arthritis typically falls into one of three categories:
- Disease-modifying anti-rheumatic drugs (DMARDs)
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
DMARDs for RA
There is no cure for RA, but DMARDs are the gold standard of RA treatment.
Each conventional (nonbiologic) DMARD is different, but they all work by slowing the inflammatory process of the body, protecting the joints from further damage. These drugs are generally prescribed shortly after diagnosis.
Which DMARD your doctor prescribes depends on numerous things, including the severity of the disease and the balance between possible side effects and the benefits of the DMARD. But because DMARDs lose their effectiveness over time, it's rare for anyone to remain on the same medication for more than two years at a time, according to the consumer health information company A.D.A.M.
The most frequently used DMARD for RA is Trexall (methotrexate), which takes up to six weeks to start working, with the full effect not seen until after 12 weeks of treatment. Common side effects include upset stomach, sore mouth, and hair thinning due to a drop in folic acid levels from the drug. Patients are often given folic acid supplements to reduce these side effects.
Your doctor may prescribe other DMARDs along with methotrexate, including:
These drugs may cause various other side effects, such as rash, abdominal pain, and vision and eye problems.
Biologic DMARDs work more quickly than conventional DMARDs — some in as few as two weeks — but must be injected by your doctor. These drugs interfere with the immune system's ability to launch the damaging inflammatory process by targeting specific steps in this process.
The first types of biologics that hit the market work by binding and inhibiting tumor necrosis factor alpha (TNF), a pro-inflammatory immune system substance. These drugs may be used in combination with methotrexate, though two biologics are never used in combination with each other. TNF inhibitors include:
- Enbrel (etanercept)
- Remicade (infliximab)
- Humira (adalimumab)
- Cimzia (certolizumab)
- Simponi (golimumab)
Other biologics target other immune system factors, such as interleukin-1 (IL-1), IL-6, CD20-positive B cells, and T cell activity. These drugs are usually only prescribed if you're unresponsive to treatments with methotrexate and a TNF inhibitor. These other biologics include:
A drug called tofacitinib (Xeljanz, Jakvinus) is also available. It belongs to a new subclass of DMARDs called JAK inhibitors, which work by blocking another part of the body's immune system response — Janus kinase (JAK) pathways. This type of DMARD, like conventional DMARDs, can be taken orally.
Corticosteroids for RA
These drugs are often used while waiting for DMARDs to take effect, and are sometimes also prescribed to enhance the effects of a DMARD. They can quickly reduce pain, stiffness, swelling, and tenderness of joints.
But corticosteroids are only used for short-term relief because they can cause a number of serious side effects in the long run, including:
NSAIDs for RA
Able to help with pain and minor inflammation, NSAIDs are used for temporary RA relief but cannot reduce the long-term damaging effects of RA or change the course of the disease.
Over time, NSAIDs can increase your risk of gastrointestinal bleeding, fluid retention, and heart disease.
Over-the-counter NSAIDs include:
Prescription NSAIDs include:
- Rheumatoid Arthritis Treatment; Arthritis Foundation.
- Rheumatoid Arthritis Medications; NYT/A.D.A.M.
- Patient education: Disease-modifying antirheumatic drugs (DMARDs) (Beyond the Basics); UpToDate.
- Patient education: Rheumatoid arthritis treatment (Beyond the Basics); UpToDate.
- Rheumatoid Arthritis Treatment; Johns Hopkins Medicine.
- Handout on Health: Rheumatoid Arthritis; National Institute of Arthritis and Musculoskeletal and Skin Diseases.
- DMARDs Overview; Arthritis Foundation.
Last Updated: 3/16/2017