Drugs and Prescription Medications for RA

Drugs are an important part of managing rheumatoid arthritis (RA), both for pain management and to slow or stop the disease process. Without treatment, chronic inflammation in the joints can lead to permanent damage and disability.¹

Drugs for RA are either symptomatic treatments or disease-modifying treatments. These drugs have different goals:¹

• Symptomatic treatments mainly focus on relieving symptoms
• Disease-modifying treatments change the course of RA and slow or prevent joint destruction while relieving symptoms

Disease-modifying anti-rheumatic drugs (DMARDs)

DMARDs decrease inflammation and work to slow or prevent further damage to the joints. Each DMARD works differently. Some DMARDs broadly restrict your immune system. Targeted DMARDs block specific pathways inside immune cells.²

Because DMARDs act on your immune system, they can increase your risk for infection. Each DMARD has risks and benefits. Talk to your doctor about which one may be right for you.²

Biologics and biosimilars

Biologics are drugs made from living cells. These cells can come from parts of the blood, proteins, viruses, or tissue. This process uses the cells to produce the biologic drug.³

Drugs that are similar in structure to known biologic drugs are called biosimilars.⁴

Biologics and biosimilars are drugs used for the treatment of RA because they help decrease inflammation. Because biologics and biosimilars affect your immune system, they can increase your risk for infection. Each drug has risks and benefits.^3,4

Non-steroidal anti-inflammatory drugs (NSAIDs)

Many NSAIDs are available over-the-counter (OTC), such as ibuprofen. NSAIDs can help provide fast relief of RA symptoms such as pain and minor inflammation. Talk to your doctor about the right dose to use for whichever NSAID you are taking. Like all drugs, NSAIDs also can cause side effects.¹

Steroids

Steroids (corticosteroids) are very effective at controlling inflammation. They may be taken in pill form, injected into a vein or muscle, or by direct injection into a joint cavity. Steroids have been shown to rapidly improve pain and tenderness, stiffness, swelling, and inflammation.¹

Unlike DMARDs, steroids do not slow or prevent RA-related damage to joints and other structures. Plus, steroids have many potential side effects, including weight gain, osteoporosis (a condition that causes the bones to become less strong and more likely to break), diabetes, and cataracts (clouding of the lens of the eye). This makes them less ideal for long-term use.¹

Steroids are typically used during an RA flare. Prednisone, prednisolone, and methylprednisolone are common steroids.¹

Other medication types

Several different classes of drugs provide pain relief in RA but do not have any effect on inflammation. These include:¹

• Analgesics (“painkillers) used to decrease pain sensation from the nervous system
• Capsaicin made from peppers, which may help with nerve pain (cream or ointment)
• Narcotic (opioid) pain relievers

Narcotic drugs can cause dependency. In general, these drugs are discouraged due to the potential for dependence with long-term use. Also, narcotic drugs do not affect inflammation.¹

Choosing the right medications

Your drug treatment for RA may be different than others with RA. Your doctor will work closely with you to strike the right balance in treating your RA symptoms while keeping side effects to a minimum. This is the key challenge of drug treatment in RA. To get the balance right, your doctor may adjust the dose of your RA drugs. You may have to try different ones until you find the best treatment.⁵

RA is not the same for every person, and not every drug works for everyone. Work with your doctor as a team to find the balance that works best for you.⁵