There is no cure for rheumatoid arthritis, a disorder in which your immune system mistakenly attacks tissue in your joints — causing painful swelling and bone erosion. But medications can relieve pain and prevent or slow joint damage.
Many drugs used to treat rheumatoid arthritis have potentially serious side effects. Doctors typically prescribe medications with the fewest side effects first. You may need stronger drugs or a combination of drugs as your disease progresses.
- NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve). Stronger NSAIDs are available by prescription. Side effects may include ringing in your ears, stomach irritation, heart problems, and liver and kidney damage.
- Steroids. Corticosteroid medications, such as prednisone, reduce inflammation and pain and slow joint damage. Side effects may include thinning of bones, cataracts, weight gain and diabetes. Doctors often prescribe a corticosteroid to relieve acute symptoms, with the goal of gradually tapering off the medication.
- Disease-modifying antirheumatic drugs (DMARDs). These drugs can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage. Common DMARDs include methotrexate (Trexall), leflunomide (Arava), hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine). Side effects vary but may include liver damage, bone marrow suppression and severe lung infections.
- Immunosuppressants. These medications act to tame your immune system, which is out of control in rheumatoid arthritis. Examples include azathioprine (Imuran, Azasan) and cyclosporine (Neoral, Sandimmune, Gengraf). These medications can increase your susceptibility to infection.
- TNF-alpha inhibitors. Tumor necrosis factor-alpha (TNF-alpha) is an inflammatory substance produced by your body. TNF-alpha inhibitors can help reduce pain, morning stiffness, and tender or swollen joints. Examples include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), golimumab (Simponi) and certolizumab (Cimzia). Potential side effects include upper respiratory infection and an increased risk of serious infections.
- Other drugs. Several other rheumatoid arthritis drugs target a variety of processes involved with inflammation in your body. These drugs include anakinra (Kineret), abatacept (Orencia), rituximab (Rituxan), tocilizumab (Actemra) and tofacitinib (Xeljanz). Side effects vary but may include itching, abdominal pain, headache, runny nose or sore throat, and increased risk of infection.
Feb. 21, 2014
- Handout on health: Rheumatoid arthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Rheumatic_Disease/default.asp. Accessed June 26, 2013.
- Bope ET, et al. Conn's Current Therapy. Philadelphia, Pa.: Saunders Elsevier; 2013. http://www.clinicalkey.com. Accessed June 26, 2013.
- Longo DL, et al. Harrison's Online. 18th ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=4. Accessed June 26, 2013.
- Frontera WR, et al. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 2nd ed. Philadelphia, Pa.: Saunders Elsevier; 2008. http://www.clinicalkey.com. Accessed June 26, 2013.
- Venables PJ, et al. Diagnosis and differential diagnosis of rheumatoid arthritis. http://www.uptodate.com/home. Accessed June 26, 2013.
- Schur PH, et al. General principles of management of rheumatoid arthritis in adults. http://www.uptodate.com/home. Accessed June 26, 2013.
- Matteson EL (expert opinion). Mayo Clinic, Rochester, Minn. July 2, 2013.
- Chang-Miller A (expert opinion). Mayo Clinic, Scottsdale, Ariz. Feb. 11, 2014.