Medication

Dozens of drugs are used to treat arthritis. They perform different roles from simply relieving pain to reducing inflammation or damping down the disease itself. You may be prescribed one, or a combination of drugs from any of the following types:

• painkillers (analgesics)
• non-steroidal anti-inflammatory drugs (NSAIDs)
• Cox-2 inhibitors
• steroids
• disease modifying drugs
• 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 as painkillers in low doses.

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

Types include:

• paracetamol
• aspirin
• ibuprofen
• codeine

Opioid patches are also available although not widely prescribed. Applied to the skin, the slow release pain killing effects last between three and seven days.

The popular drug co-proxomal is being gradually withdrawn following overdosing concerns.

• Doctors are being encouraged to prescribe people other pain relieving drugs instead.
• However, until December 2007 it will remain available to patients where the doctor has concluded that other painkillers are not proving effective.
• After 2007, it is expected to be available only under special rules.

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 taking anti-ulcer drugs

Types of NSAIDs include:

• naproxen (Naprosyn and others)
• ibuprofen (Brufen, Nurofen and others)
• diclofenac (Voltarol, Diclomax)
• meloxicam (Mobic)

Cox-2 inhibitors

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

They include:

• celecoxib (Celebrex)
• etodolac (Lodine SR)
• etoricoxib (Arcoxia)
• meloxicam (Mobic)

Concerns have been raised about their side effects, including increased risk of cardiovascular problems, especially for people with a history of heart disease or stroke. 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’re usually used soon after diagnosis.

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

Types include:

• gold by injection (includes Myocrisin) or tablets (includes Ridaura)
• sulphasalazine (include Salazopyrin EN, Sulazine)
• methotrexate (includes Maxtrex)
• ciclosporin (includes Neoral)
• anti-malarial drugs (includes Plaquenil)
• leflunomide (Arava)

Anti-TNF therapy

Anti-TNFs 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 suitable for everyone, but they can offer new hope to people with severe rheumatoid arthritis or psoriatic arthritis who have not been helped by older disease-modifying drugs. 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 a suitable candidate.

You may be prescribed one of the following:

• 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

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.