Medication for arthritis

There are numerous drugs available to treat arthritis which acts upon these symptoms in a variety of ways. Some of these drugs ease the pain of arthritis whereas others reduce inflammation and the build up of fluid. Others prevent further spread of the disease and reduce the risk of a disability.

The idea behind these drugs is to relieve your symptoms and enable you to live as normal a life as possible. They aim to slow down the rate of progression which is a common feature of arthritis.

The type of drug or drugs you are prescribed will depend upon the type of arthritis you have. Some people only require a single drug but others have a combination of drugs.

These are used to control the symptoms of arthritis along with diet and exercise, splints, physiotherapy and occupational therapy.

Types of arthritis drugs

These include:

• Non-steroidal anti-inflammatory drugs (NSAID’s)
• Painkillers (analgesics)
• Painkilling patches
• Corticosteroids
• Biological drugs (Anti-TNF’s)
• Disease modifying anti-rheumatic drugs (DMARDS)

These drugs either control the symptoms of arthritis or affect the entire disease.

We have also included in this section:

• Important issues regarding arthritis drugs

These are a few pointers for you to consider when taking any type of arthritis medication.

Non-steroidal anti-inflammatory drugs (NSAIDs)

A well known form of medication used to treat arthritis especially osteoarthritis. They work by relieving the pain and stiffness caused by inflammation in the joints but without using steroids.

Hence the use of the name ‘non-steroidal anti-inflammatory’ for this group of drugs.

Examples of these include ibuprofen, aspirin, diclofenac and naproxen.

They are often used in conjunction with over the counter painkillers.

NSAIDs are available as tablets, capsules, liquid, gels, topical creams and suppositories. Some of these are designed to be taken once a day whereas others can be ingested 2 or 3 times in a day.

Your GP will advise you about the correct time and dosage. He or she will prescribe the lowest dose possible (which is still effective) and for the least amount of time. The reason for this is that NSAIDs have side effects which usually occur after taking these drugs for a long period of time.

These drugs usually work within a few hours although it can be as much as 2 weeks before you notice the benefits.

There is newer version of these drugs called ‘Cox-2 inhibitors’which behave in the same way as the existing drugs but with less risk of side effects. Examples of these include arcoxia and celebrex (brand names).

Side effects with NSAID’s include:

• Increased risk of heart disease
• Increased risk of a stroke
• Increased risk of high blood pressure
• Increased risk of asthma
• Increased risk of kidney problems

Other side effects include stomach ulcers and similar digestive problems. But your GP will also prescribe another medication to be taken in conjunction with an NSAID. This medication is known as a ‘proton pump inhibitor’ (PPI).

It works by reducing the amount of acid produced in your stomach by NSAID’s which can damage the lining of the stomach. PPI’s are usually prescribed where NSAID’s are taken orally (tablets or capsules).

Many of these risks such as heart disease and strokes are small but if you suffer from either of these conditions then NSAID’s are not recommended.

Your GP will discuss other types of medication with you if you are not suitable for NSAID’s.

Painkillers (analgesics)

You are probably familiar with these drugs as many of them can be purchased over the counter at your local pharmacy. But the stronger versions are available on prescription only.

The most popular form of painkiller is Paracetamol.

They do exactly as their name says: they ease pain and discomfort caused by arthritis.

Painkilling patches

These are a newer form of painkiller, available in patch form. This patch is placed on the surface of your skin which absorbs the drugs from this patch. These drugs are slowly released into the bloodstream and ease pain over a period of several days.

Corticosteroids

Often called ‘steroids’for short: this group of drugs are effective at reducing inflammation caused by arthritis. They are taken either as a tablet or more commonly as an injection.

But there are side effects with these which include osteoporosis. This is a risk if high doses of steroids are used for a long period of time.

Your GP will try and minimise these risks by prescribing a low dose steroid and/or reducing the amount of time you take steroids. He or she will also look at treatment to minimise the risk of damage to your bones.

The most commonly used steroid for arthritis is prednisolone. This is available as a tablet and is effective at reducing the inflammation caused by various forms of arthritis such as rheumatoid arthritis and polymyalgia rheumatica.

Biological drugs

This refers to a group of drugs called ‘Anti-TNF’drugs which obstruct a chemical called tumour necrosis factor or TNF for short. This chemical plays an important role in helping to spread inflammation throughout the joints of the body.

This is a particular issue with rheumatoid arthritis, ankylosing spondylitis and other similar forms of arthritis.

They are a good option for people whose symptoms have not responded to other forms of medication. Examples of these include adalimumab, etanercept and infliximab.

(Source: www.arthritiscare.org.uk)

But Anti-TNF drugs are not suitable for everyone. They have side effects which include infection, kidney/liver problems and the risk of mild heart failure.

Anti-TNF drugs are usually taken in combination with methotrexate. Methotrexate is one of several types of drugs known as ‘disease modifying anti-rheumatic drugs’ or DMARD’s for short. They are discussed in more detail in the next section.

Disease modifying anti-rheumatic drugs

These are more commonly known as DMARD’s for short: they are commonly used to treat rheumatoid arthritis but work equally well on ankylosing spondylitis, psoriatic arthritis and juvenile idiopathic arthritis.

Juvenile idiopathic arthritis is a form of arthritis which mainly affects children and is discussed separately in our arthritis in children section.

These drugs work by reducing the symptoms of pain, stiffness and inflammation. But it will be several weeks before you notice any improvement.

But they are effective at slowing down the progression of arthritis.

Examples of these drugs include methotrexate, gold and sulfasalazine.

This section also includes another group of drugs known as ‘immunosuppressants’. These work by suppressing the body’s immune system which often plays a part if the development of certain forms of arthritis such as rheumatoid arthritis.

But this suppression also reduces the effectiveness of the immune system which can leave the sufferer vulnerable to infections. This dampening down effect also causes side effects.

If you are prescribed immunosuppressants then your GP will monitor your condition as a precautionary measure. This is important as these side effects can be serious.

Important issues regarding arthritis drugs

Many people with arthritis are prescribed more than one drug. In fact, it is common practice to take several drugs in combination with each other as they all work in different ways.

Some drugs reduce inflammation whereas others prevent the arthritis from spreading to other joints in the body.

A popular combination is a single NSAID, a painkiller and one or two DMARD’s.

If one drug fails to work then you will be prescribed another. This is also the case if you experience severe side effects from taking a particular drug.

Some drugs work almost straightaway but others will take several months to act on your arthritis. So it is a matter of being patient whilst waiting for the drugs to work.

Some types of drugs are started off at a low dose which gradually increases to a higher dosage. Conversely, some drugs are taken in high doses but are gradually reduced to smaller doses.

Arthritis medication is taken in a variety of ways. Some drugs are designed to be taken orally, either as a tablet or a capsule. Others are available as an injection only.

Follow any instructions given to you by your GP, specialist or pharmacist to the letter. If you are uncertain about a dosage or when to take a particular drug then ask. Do not try and catch up if you miss a dose by taking a ‘double’ amount.