Medication for Rheumatoid Arthritis

In recent years, there have been numerous advances in treating rheumatoid arthritis. NYU Langone rheumatologists prescribe several medications that help alleviate symptoms, preserve joint function, and prevent joint and organ damage. These medications may even enable some people to achieve remission, in which there are no symptoms for an extended period of time.

People with rheumatoid arthritis typically take a combination of medications. Over time, your doctor may adjust your prescriptions depending on how you respond to the medications.

Disease-Modifying Antirheumatic Drugs

Medications that are given to stop the progression of rheumatoid arthritis or to put the condition in remission are called disease-modifying antirheumatic drugs. These medications slow the progression of the disease. They prevent inflammation and joint damage by suppressing the immune system.

Your doctor may prescribe one or more of these medications, depending on the severity of your condition and your response. It can take several weeks to months to control the inflammation.

One of the most commonly prescribed medications in this class is methotrexate. It interferes with your body’s production of blood cells, sometimes resulting in a low white blood count level, which can increase the risk of infection.

People taking methotrexate are discouraged from drinking alcohol because the medication can cause liver damage—and alcohol may exacerbate the problem.

If you are taking methotrexate long-term, your doctor needs to monitor you with frequent blood tests to assess liver function and blood count. Common side effects include abdominal pain and dizziness.

Biologic Response Modifiers

Biologic response modifiers, also known as biologics, comprise the newest class of rheumatoid arthritis medications. They are designed for people with moderate to severe rheumatoid arthritis who have not responded well to other medications. Most biologics work by blocking a chemical called tumor necrosis factor, which is thought to cause inflammation in the joints.

Anti-tumor necrosis factor agents are the most common type of biologic. They include etancercept (Enbrel®), infliximab (Remicade®), golimumab (Simponi®), adalimumab (Humira®), and certolizumab (Cimzia®).

Other biologics, which work by inhibiting other molecules that cause inflammation, include abatecept (Orencia®), tocilizumab (Actemra®), rituximab (Rituxan®), and tofacitinib citrate (Xeljanz®).

Biologics can be prescribed on their own or in conjunction with other disease-modifying antirheumatic drugs, such as methotrexate, for people with severe symptoms.

At this time, Xeljanz® is the only biologic that can be taken by mouth. Most biologics are given by injection—anywhere from weekly or twice a week to once a month. Your doctor or nurse can teach you how to give yourself the injection at home.

Other biologics, such as infliximab, are administered through a vein with intravenous (IV) infusion or through a needle or a catheter. This is done at an infusion center in your doctor’s office every few weeks and can take up to three hours. You are able to read, rest, or watch television while receiving the infusion.

Common side effects include skin reactions, such as redness or irritation at the injection site.

These medications affect your body’s ability to fight infection and should not be used if you have a chronic infection, such as tuberculosis. Most people are tested for tuberculosis before starting a biologic. After that, they are tested annually, because the medication can reactivate the illness in a person who has been exposed to tuberculosis.

People with rheumatoid arthritis who have recently had cancer should also avoid biologics, as should people with systemic lupus erythematosus, multiple sclerosis, or congestive heart failure.

Corticosteroids

Corticosteroids, also known as steroids, help decrease inflammation by suppressing the activity of infection-fighting white blood cells. Doctors usually prescribe steroids to treat severe flare-ups.

If you use steroids over a period of a few weeks or months, they can cause potentially serious side effects, such as cataracts, the bone-thinning condition osteoporosis, obesity, and high blood sugar, among other conditions. For this reason, doctors prescribe steroids with caution and usually not for an extended period of time.

Non-Steroidal Anti-Inflammatory Drugs

Rheumatologists commonly prescribe non-steroidal anti-inflammatory drugs, or NSAIDs, to relieve pain and curb inflammation while waiting for disease-modifying antirheumatic drugs to start working. Popular NSAIDs include aspirin, ibuprofen, and naproxen. Doctors suggest taking these medications for just a few weeks and only as needed after the disease-modifying antirheumatic drugs control the arthritis.

If you take NSAIDs for an extended period of time, they can lead to heartburn, vomiting, or stomach bleeding. Your doctor helps you determine the best dosage and duration based on your symptoms and health.

Painkillers

Doctors may prescribe analgesics, commonly known as painkillers, to relieve joint pain. Although they can ease discomfort, they don’t have any effect on inflammation. They should only be taken for limited periods of time, because many of these medications can become addictive.

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