Medication

Dozens of drugs are used to treat arthritis. Some relieve pain, others reduce inflammation and others control the underlying disease.

You may be prescribed one, or a combination of drugs from any of the following types:

• painkillers (analgesics)
• non-steroidal anti-inflammatory drugs (NSAIDs), including Cox-2 inhibitors
• steroids
• disease modifying anti-rheumatic drugs (DMARDs)
• biologics, including anti-TNFs

Painkillers (analgesics)

Painkillers are used to provide pain relief. They come in different strengths – some can be bought over the counter in shops while stronger ones are prescribed by a doctor. Some anti-inflammatory drugs such as aspirin and ibuprofen can be used in low doses as painkillers.

Always keep to the dose stated on the packet. If in doubt, talk to your pharmacist or doctor.

Types include:

• paracetamol
• aspirin
• ibuprofen
• codeine

Painkilling patches are also available although not widely prescribed. They are put on the skin, and the slow release pain killing effects last from three to seven days.

The popular drug co-proxamol was withdrawn at the end of 2007 due to concerns about overdosing. Doctors are being encouraged to prescribe other pain relieving drugs instead, but if no other drugs are effective for you, they may be able to prescribe it on a named patient basis.

Non-steroidal anti-inflammatory drugs (NSAIDs)

NSAIDs reduce inflammation and joint swelling as well as providing some pain relief. Taken over a long time they can cause stomach problems and other side effects.

You can help minimise this by:

• making sure you take your tablets with or after meals
• keeping alcohol to a minimum
• not smoking

• asking your doctor about anti-ulcer drugs

Types of NSAIDs include:

• ibuprofen (Brufen, Nurofen and others)
• diclofenac (Voltarol, Diclomax and others)
• nabumetone (Relifex)
• indometacin (Indocid and others)
• naproxen (Naprosyn and others)
• piroxicam (Feldene)
• meloxicam (Mobic)
• etodolac (Lodine SR)

Cox-2 inhibitors are a newer type of NSAID, designed to be safer for the stomach.

They include:

• celecoxib (Celebrex)
• etoricoxib (Arcoxia)

Concerns have been raised about the side effects of NSAIDs, including a slightly increased risk of cardiovascular problems, especially for people with a history of heart disease or stroke. The current medical advice is that people who have had stroke or heart trouble before should not take NSAIDs.

You will need to discuss with your doctor whether this type of treatment is suitable for you.

Steroids

Steroids are manufactured versions of the body’s natural hormones and can be very effective in reducing inflammation. Taken long-term, they can also cause side effects and osteoporosis. Your doctor will try to give you the lowest possible effective dose and you will be carefully monitored. Never stop taking steroids suddenly.

Steroids can also be given by injection into an inflamed joint. Used this way they don’t cause the same side effects.

Types include:

• cortisone
• prednisolone (includes Deltacortril, Enteric, Predsol)

The Department of Health recommends that all people taking steroid tablets and immunosuppressants (see below) should have yearly flu and pneumonia vaccinations.

Disease modifying anti-rheumatic drugs

Disease modifying anti-rheumatic drugs (DMARDs) treat forms of inflammatory arthritis such as rheumatoid arthritis and lupus.

This family of drugs includes immunosuppressants which damp down the activity of the immune system. DMARDs slow the disease’s progress and reduce the amount of damage it does – so they should be used soon after diagnosis.

They can have serious side effects, so you will be carefully monitored.

Types include:

• methotrexate (includes Maxtrex)
• sulphasalazine (includes Salazopyrin EN, Sulazine)
  

• azathioprine (Azamune or Imuran)

• ciclosporin (includes Neoral) 

• cyclophosphamide (Endoxana)

• hydroxychloroquine (includes Plaquenil)
  
• gold by injection (includes Myocrisin)
• leflunomide (Arava)

Biologic treatments

Anti-TNFs are a type of biologic drug that work by blocking the action of a chemical called tumour necrosis factor (TNF). TNF is thought to play an important role in driving the inflammation and tissue damage in certain kinds of inflammatory arthritis.

They are not free of side effects and aren’t appropriate for everyone. They can offer good control to some people with severe inflammatory arthritis, who have not responded well to other disease-modifying drugs by themselves.

Anti-TNFs are often taken in conjunction with methotrexate. Strict guidelines have to be followed in assessing who is eligible. Ask your rheumatologist whether you could be eligible.

You may be prescribed one of the following anti-TNFs:

• adalimumab (Humira), given by fortnightly injections (usually at home, by you or someone else).
• etanercept (Enbrel), given by once or twice-weekly injections (usually at home, by you or someone else)
• infliximab (Remicade), given by infusion every eight weeks in hospital

Other biologic drugs target other specific parts of the immune system that drive the inflammation. Rituximab (Mabthera), is one such drug that can be used if you do not have an adequate response to an anti-TNF drug. It is given by two infusions in hospital, two weeks apart (once or twice a year).

For more specific information on particular drugs, take a look at Arthritis Care’s information booklet, Drugs and Complementary Therapies, contact the Arthritis Care Helpline, or speak to your doctor.