Arthritis and Rheumatism

What Medicines are used for Arthritis?

The major complaint arthritis sufferers have is pain. For mild pain simple analgesics (pain killers) are adequate. An example is acetaminophen (Tylenol). The advantage of analgesics is that they are relatively safe and for mild arthritis-related pain, they are effective. The downsides are that for more severe pain they may not be enough.

A previous article discussed non-drug treatment for arthritis. This article will discuss some of the medicines that are used.

The major complaint arthritis sufferers have is pain. For mild pain simple analgesics (pain killers) are adequate. An example is acetaminophen (Tylenol). The advantage of analgesics is that they are relatively safe and for mild arthritis-related pain, they are effective. The downsides are that for more severe pain they may not be enough. Also, acetaminophen taken long term has significant toxicity related to kidney and liver damage and hypertension.

A step up are non-steroidal anti-inflammatory drugs (NSAIDS). These drugs block inflammation and relieve pain, swelling, redness, and heat. Examples include ibuprofen (Motrin), naproxyn (Naprosysn), etodolac (Lodine), and nabumetone (Relafen). COX-2 drugs such as Celebrex are also anti-inflammatory drugs. Other COX-2 drugs- Vioxx and Bextra - were taken from the market because of concerns over their cardiovascular safety.

While often effective for more severe arthritis symptoms, they also may not be strong enough. They also do not slow the course of arthritis progression. In addition, they have significant toxicity including stomach ulcers, liver and kidney damage, as well as the increased tendency for all of these NSAIDS, not just the COX-2 drugs, to cause cardiovascular events such as stroke and heart attack.

Another type of anti-inflammatory drug that should be used with caution by an experienced rheumatologist is prednisone. This is a corticosteroid and has powerful anti-inflammatory effects. It also has many potential side effects.

For more severe kinds of arthritis such as rheumatoid arthritis and psoriatic arthritis, a category of medicines called disease modifying anti-rheumatic drugs are needed.

These drugs help to slow down progression of disease. Examples include hydroxychloroquine (Plaquenil), metrhotrexate, sulfasalazine (Azulfidine), and azathioprine (Imuran). Newer drugs called biologic response modifiers (BRMS) are even more effective and have revolutionized our approach to treating arthritis. Examples include etanercept (Enbrel), adalimumab (Humira), and infliximab (Remicade). These drugs also have potential side effects including lowered resistance to infection, reactivation of tuberculosis, a neurologic disorder similar to multiple sclerosis, and possibly an increased incidence of lymphoma.

Newer second generation biologic therapies such as Rituxan and Orencia are also being used with success.

Not all types of arthritis are treated with the medicines described above. For instance, gout, a crystal-induced form of arthritis is treated with drugs to lower uric acid in the blood.

Lyme disease is an infectious form of arthritis and is treated with antibiotics.

Fibromyalgia is a form of arthritis treated often with serotonergic drugs.

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