Medications used for Rheumatoid arthritis

The inflammation caused by RA results in damage to the joints. The main way to stop or at least reduce joint damage is by giving medications that suppress inflammation. Disease-Modifying Anti-Rheumatic

DMARDs

Disease-Modifying Anti-Rheumatic Drugs

These can also be described as slow-acting anti-rheumatic drugs (SAARDs). These drugs suppress inflammation and may also retard the development of joint erosions. The exact reason for their effectiveness is at this stage not well understood. Their effectiveness in their ability to slow the progression of erosions is judged through the use of X-rays.

With DMARDs early diagnosis and treatment of RA is important in the aim of preventing joint deformity and disability. DMARDs take 6-8 weeks to achieve beneficial effects. Treatment with these drugs should be closely monitored. Regular blood and urine tests are often done to identify side effects and potential problems as soon as possible.

DMARDs that are used in the treatment of RA.

Methotrexate (e.g. Ledertrexate, Methoblastin) may be used in moderate to severe rheumatoid arthritis. This medication can be taken orally or by intramuscular injection. Supplements of folic acid are recommended to alleviate side effects such as nausea and mouth ulcers. Methotrexate It is potentially toxic to the liver. Methotrexate is the leading DMARD in the fight against inflammation in RA.

Sulfasalazine such as Pyralin EN and Salazopyrin EN. These drugs while less potent, have fewer adverse side effects and are used in the treatment of mild RA. These however can still cause nausea, dyspepsia, diarrhea, rash and headaches. These side effects however are reduced once the maintenance dose is reached. It can also lead to severe anemia on occasion.

Leflunomide (e.g. Arava). Used for severe active RA that does to methotrexate. Leflunomide is as effective as methotrexate in the treatment of RA.

Antimalarials such as hydroxychloroquine sulfate such as Plaquenil are also used in the treatment of mild rheumatoid arthritis. They are less toxic than some of the other treatments. Plaquenil is often used in combination with other DMARDs.

Azathioprine (e.g. Imuran) is used to treat only severe active RA that is unresponsive to other DMARDs. Because of high toxicity it is rarely used.

(NSAIDs)

Non-steroidal anti-inflammatory drugs

These drugs are prescribed as pain killers. They may also reduce inflammation inflammatory forms of arthritis, such as RA. They have no effect on the progress of the disease but may relieve symptoms. Ibuprofen such as Nurofen or Tri-Profen and naproxens such as Naprogesic are available without prescription. Drugs such as such as diclofenac, piroxicam, sulindac and indomethacin have to be prescribed by a doctor.

The use of NSAIDs is often limited because they increase the risk of upper gastrointestinal problems, such as gastric ulcer. They are not suitable for use by people who have had a peptic ulcer or gastrointestinal bleeding.

COX-2 specific inhibitors

The coxibs (e.g. celecoxib - brand name Celebrex) These are non-steroidal anti-inflammatory agents. They are effective in reducing inflammation and relieving pain and are far gentler on the stomach than the conventional, older NSAIDs. Coxibs may be associated with an increased risk of cardiovascular events, such as heart attack and stroke, when taken in high doses. People with an increased risk of heart attack or stroke are advised not to use these medications.

Corticosteroids

Corticosteroids, also known as glucocorticoids, such as prednisone and prednisolone, are medications that reduce inflammation and suppress the immune system. These agents are used in the treatment of RA, both as tablets and as injections into the joint. Prednisolone is sometimes used in moderate to severe RA where NSAIDs and DMARDs are not controlling the disease. Oral corticosteroids (those taken by mouth) are usually used at the lowest effective dose to minimize adverse effects such as weight gain, hypertension (high blood pressure) and osteoporosis.

Corticosteroids may also be injected into joints if the arthritis is not being controlled through oral therapy, however this has to be limited to 3 to 4 injections a year. Joints commonly injected are fingers, toes, knees and shoulders. Corticosteroids are also sometimes injected into the muscles.

Biologic agents

A new category of arthritis treatments called tumour necrosis factor (TNF) inhibitors has been developed. TNF inhibitors occur naturally in the body and are key players in the process of inflammation in rheumatoid arthritis. It is found in high concentration in the joint fluid of people with RA. By attaching to the TNF, these new agents can block its effect.

Infliximab (e.g. Remicade) is a TNF inhibitor available for the treatment of RA in selected patients. It slows the progression of RA and reduces joint damage. Inflixmab is given by infusion via a drip into a vein. Each treatment takes approximately 2 hours. It is given along with methotrexate. There are very tight Government restrictions In Australia on which patients with RA can obtain access to Remicade because of the expense involved.

Etanercept (e.g. Enbrel)

Humira (adalimumab),

Stem cell research

There is some promising work happening in the field of stem cell work where new cartilage and bone tissues can be developed inside the patient to repair damaged joints However it is still early days. But human tests have begun in Australia after successes in sheep.

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