Model Monday's: Diana Moldovan
Rheumatoid Arthritis Medication List
There are many medication options for treating rheumatoid arthritis (RA). This includes DMARDs, biologics, immunosuppressants, and JAK inhibitors. Your doctor can recommend the best treatment for you.
Rheumatoid arthritis (RA) is one of the most common forms of arthritis.
RA is an inflammatory and autoimmune disease. It occurs when your body attacks its own healthy joint tissues. This results in redness, inflammation, and pain.
The main goal of RA drugs is to block inflammation to help prevent joint damage.
Read on to learn about the many treatment options for RA.
DMARDsDisease-modifying antirheumatic drugs (DMARDs) are used to decrease inflammation. Unlike other medications that temporarily ease pain and inflammation, DMARDs can slow the progression of RA. This means you may have fewer symptoms and less damage over time.
The most common DMARDs used to treat RA include:
Biologics are injectable drugs. They work by blocking specific inflammatory pathways made by immune cells. This reduces inflammation caused by RA. Doctors prescribe biologics when DMARDs alone aren't enough to treat RA symptoms.
Biologics aren't recommended for people with compromised immune systems or an infection. This is because they can raise the risk of serious infections.
The most common biologics include:
Your doctor may prescribe JAK inhibitors if DMARDs or biologics aren't treating your RA as well. These medications affect genes and the activity of immune cells in the body. They help prevent inflammation and stop damage to joints and tissues.
The American College of Rheumatology (ACR) classifies JAK inhibitors as targeted synthetic DMARDs.
JAK inhibitors include:
Before starting a JAK inhibitor, ask your doctor to ensure you're up to date on all immunizations, including prophylactic zoster vaccinations (shingles vaccine).
The more common side effects of these drugs include:
Acetaminophen is available over the counter (OTC) without a prescription. It comes as an oral drug and a rectal suppository.
Other drugs are much more effective at reducing inflammation and treating pain in RA. This is because acetaminophen can treat mild to moderate pain, but it doesn't have any anti-inflammatory activity. So, it doesn't work very well to treat RA.
This drug carries the risk of serious liver problems, including liver failure. Only take one drug that contains acetaminophen at a time.
NSAIDs are among the most commonly used RA drugs. Unlike other pain relievers, NSAIDs seem to be more effective in treating symptoms of RA. This is because they prevent inflammation.
Some people use OTC NSAIDs. However, stronger NSAIDs are available with a prescription.
Side effects of NSAIDs include:
In rare cases, these side effects can cause death. If you use NSAIDs for a long time, your doctor will monitor your kidney function. This is especially likely if you already have kidney disease.
Ibuprofen (Advil, Motrin IB, Nuprin)OTC ibuprofen is the most common NSAID. Unless instructed by your doctor, don't use ibuprofen for more than several days at a time. Taking this drug for too long can cause stomach bleeding. This risk is greater in older adults.
Ibuprofen is available in prescription strengths as well. In prescription versions, the dosage is higher. Ibuprofen may also be combined with opioids, another type of pain drug. Examples of these prescription combination drugs include:
Naproxen sodium is an OTC NSAID. It's often used as an alternative to ibuprofen. This is because it causes slightly fewer side effects. Prescription versions of this drug offer stronger dosages.
Aspirin (Bayer, Bufferin, St. Joseph)Aspirin is an oral pain reliever. It's used to treat mild pain, fever, and inflammation. It can also be used to prevent heart attack and stroke.
Prescription NSAIDsWhen OTC NSAIDs don't relieve your RA symptoms, your doctor may prescribe a prescription NSAID. These are oral drugs. The most common options include:
Other NSAIDs include:
This is an oral drug that combines the NSAID diclofenac with misoprostol. NSAIDs can cause stomach ulcers. This drug helps prevent them.
Topical capsaicin (Capsin, Zostrix, Dolorac)Capsaicin topical OTC cream may relieve mild pain caused by RA. You rub this cream on painful areas of your body.
Diclofenac sodium topical gel (Voltaren 1%)Voltaren gel 1% is an NSAID for topical use. This means you rub it on your skin. It's approved to treat joint pain, including in your hands and knees.
This drug causes similar side effects to oral NSAIDs. However, only about 4 percent of this drug is absorbed into your body. This means you may be less likely to have side effects.
Diclofenac sodium topical solution (Pennsaid 2%)Diclofenac sodium (Pennsaid 2%) and 1.5% are topical solutions used for knee pain. You rub it on your knee to relieve pain.
Opioids are the strongest pain drugs on the market. They're only available as prescriptions.
Opioids come in oral and injectable forms. They're only used for severe RA that is causing intense pain since opioids can lead to dependence. If your doctor prescribes an opioid, they'll monitor you closely.
People with RA who take opioids should also use other treatments. This is because opioids only change the way you experience pain. They don't slow down the disease or prevent inflammation.
Opioids include:
Corticosteroids are also called steroids. They come as oral and injectable drugs. These drugs can help reduce inflammation in RA. They may also help reduce the pain and damage caused by inflammation. These drugs aren't recommended for long-term use.
Side effects can include:
Steroids used for RA include:
These drugs fight the damage caused by autoimmune diseases such as RA. However, these drugs can also make you more prone to illness and infection. If your doctor prescribes one of these drugs, they'll monitor you closely during treatment.
These drugs come in oral and injectable forms, like cyclophosphamide (Cytoxan).
Work with your doctor to find the RA treatment that works best for you. With so many options available, you and your doctor are likely to find one that eases your RA symptoms and improves your quality of life.
Autoimmune Blistering Disorders
Autoimmune blistering disorders (also called autoimmune blistering diseases or autoimmune bullous disorders) are a group of rare skin diseases. They happen when your immune system attacks your skin and mucous membranes -- the lining inside your mouth, nose, and other parts of your body. This causes blisters to form.
Researchers have found many types of this disorder. Although there's no cure for them, your doctor can give you treatments to help heal the blisters and prevent complications.
Autoimmune blistering disorders are broken down into different types. These are some of the main ones:
Pemphigus is a group of disorders that cause blisters to form on the skin and inside the mouth, nose, throat, eyes, and genitals. They are soft and can break open easily.
Pemphigoid is another group. It has three main types:
IgA mediated bullous dermatoses are disorders in which the immune system makes a lot of immunoglobulin A (IgA), a type of antibody that fights bacteria, toxins, and viruses. It comes in two types:
Epidermolysis bullosa acquisita mostly affects middle-aged and older adults. It makes the skin so fragile that blisters form from minor injuries.
The places on your body where blisters form depends on which disorder you have. Some autoimmune blistering disorders cause blisters to grow on the skin. Other types cause them to form in the mucous membranes that line the mouth, nose, throat, eyes, and genitals.
They can be painful or itchy. They can break open and leave a sore.
When your immune system is working as it should, it attacks bacteria and other invaders before they can make you sick. In autoimmune blistering disorders, your system mistakes healthy cells in your skin and mucous membranes for unwanted intruders.
Your immune system makes proteins called antibodies. These attack the substances that hold the outer (epidermis) and inner (dermis) layers of skin together. The damage causes the two layers of skin to separate. Fluid collects between the two and forms blisters.
Doctors don't know what causes the immune system to misfire. Some people have genes that make them more likely to get one of these disorders. Then, something actually triggers it, such as:
Some medicines can also cause autoimmune blistering disorders. These include:
Usually, the blisters go away once you stop taking the medicine causing them.
Blisters can cause long-term problems if they form in certain parts of the body or break open.
You'll see a dermatologist. They will look at your skin and see where the blisters have formed.
You might get one or more of these tests:
Sometimes it's hard to tell the difference between autoimmune blistering disorders and other conditions, including:
Your doctor will decide on a treatment based on your symptoms. Medicines for these disorders lower the immune system response and prevent it from attacking your skin and mucous membranes. Treatments might include prescriptions from these classes of drugs:
For more serious cases, your treatments might include:
Blisters that pop open can get infected. These drugs help prevent an infection:
To prevent infections and help you stay more comfortable, take care of your blisters. Keep them clean the way your doctor recommends. Try not to pop them. This can leave scars. If a blister is in an uncomfortable place such as your foot, your doctor can release the fluid with a clean needle. Also:
Each person with autoimmune blistering disorders is different. Some people have only mild blisters that go away on their own. Others have more severe skin problems that are harder to treat. Talk to your doctor about your situation. Try different treatments until you find one that works for you.
How To Prevent Arthritis: What Experts Say
There is no definite way to prevent arthritis, as certain risk factors—such as sex, genetics and age—can't be controlled. However, certain lifestyle factors can increase the risk of arthritis and are preventable.
Maintaining a healthy weightBeing overweight is a risk factor for developing OA in the knees and can cause arthritis to advance more quickly. Not only can maintaining a healthy weight mitigate the risk of arthritis, it can also reduce arthritic pain and improve joint function in those who already have the condition.
"Maintaining a healthy weight is very important, and in addition to the cardiovascular benefits, can help lower the chances of developing OA," says Dr. Chowdhury.
Following an anti-inflammatory dietResearch suggests that diet plays a role in the risk of developing RA and its progression. Certain foods can be beneficial in lowering the risk of arthritis, while other foods can have the opposite effect.
"Processed sugars are pro-inflammatory, and I typically suggest patients stay away [from those types of food]," says Dr. Chowdhury.
In addition to sugar, red meat, high calorie foods and refined carbohydrates, salt can also increase risk of inflammation or worsen existing inflammation.
"Foods such as turmeric have an anti-inflammatory component and may be a good option to incorporate into your diet," adds Dr. Chowdhury.
Other foods that help fight inflammation include certain oils, such olive oil and flaxseed oil, fatty fish, vegetables, citrus fruits and other staples of the Mediterranean diet.
Incorporating low-impact exerciseCartilage can't rebuild itself, so once it's eroded, it can't be restored with exercise. However, resistance training can increase bone density, which can help protect joints from injury.
"Exercise is so important for managing chronic osteoarthritis," says Alexander Van der Ven, M.D., an orthopedic surgeon with Baptist Health Orthopedic Care in Florida.
"Once you've made a diagnosis of what your condition is, it really is important to find ways to stay active and to maintain your physical function, even if [that means] living with some level of pain," says Dr. Van der Ven.
In fact, a study on 264 individuals with knee or hip OA found that participation in a supervised exercise program resulted in decreased pain and increased quality of life among participants after three months, which persisted at the 12-month follow-up.
Aquatic therapy has also been shown to alleviate pain in patients with OA.
Quitting smokingSmoking increases the risk of cancer, lung disease and heart disease and is also a risk factor for RA. Smoking can also make the disease worse.
While the exact pathogenic effect of smoking on RA is still uncertain, the association of smoking and the development of RA is demonstrated in studies. A 2020 study of 3,311 RA patients (1,012 former smokers, 887 current smokers and 1,412 who never smoked) found that current smokers were more likely to have moderate or high disease activity compared with former and never smokers and that quitting smoking is associated with lower RA disease activity.
Smoking can also make it more difficult to exercise, which is an important part of managing arthritis symptoms.
Avoiding injury and joint traumaWhile regular exercise is important for managing arthritis, participation in sports such as soccer, football, long-distance running and weight lifting may increase the likelihood of knee OA because of the risk of joint trauma.
Actions such as twisting, turning and jumping can cause heavy force to the knee joint that when accumulated over the years may play a role in joint degeneration.
"We know that cartilage can accommodate a slowly applied load better than an impact load which can cause injury if above a certain threshold," Dr. Chowdhury says.
"That being said … as long as one avoids trauma, regardless of whether there is pre-existing disease or not, moderate exercise does not accelerate knee osteoarthritis and is actually associated with better physical functioning and reduction of pain and disability," Dr. Chowdhury says.
A health care provider, physical therapist or certified personal trainer with experience working with people who have arthritis can help create an exercise routine that's safe, manageable and beneficial.
Keeping up on regular doctors appointmentsWhile arthritis is not necessarily preventable, regular visits to the doctor and health screenings can help to control risk factors associated with arthritis.
"A doctor can have a discussion with you regarding healthy diet and exercise habits and identify underlying issues that may predispose you to arthritis—things like being flat footed or 'knock kneed' or 'bow legged,'" Dr. Chowdhury says.
"These issues can usually be addressed with physical therapy and/or a brace if they are caught soon enough."
Getting an accurate diagnosis early on and following your treatment plan can minimize symptoms and prevent the disease from getting worse. Seeing a doctor regularly is especially important for certain types of arthritis, such as lupus, rheumatoid arthritis and gout—and for those with other chronic conditions like diabetes or heart disease.
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