Changes to medication

A change from your current medication may take some getting used to, but it is about finding what works best for you. There are many reasons why you or your doctor will have decided that you need to make a change. It could be that your current medication is not effective or has side effects. Your condition may also have improved or worsened or a new medication could have become available.

Each medication will have different advantages and disadvantages. Make sure you understand how your particular medications work and how soon you can expect to see an effect. Follow the advice given by your doctor or pharmacist on how and when to take your medications, and don’t be afraid to book another appointment if you have any concerns.

Because there are more than 200 types of arthritis, it’s impossible to say here exactly why your doctor has decided to change the sort of drugs you’re taking, or the amount you need to have. Added to this, you are an individual and there may be times when you simply have to try different treatments just to see what works best for you.

If you need to change your drugs, try not to get anxious about it. Ask your doctor or someone in your care team to explain the reasons to you. The Arthritis Care Drugs and complementary therapies booklet will help you understand more about the types of drugs out there and what they do. And even though changing your medication can sometimes be unsettling – especially if you’ve got into a routine – persevere. Try to remember that lots of people who have managed to get their arthritis and pain under control have done this over time, not overnight.

It could mean either or neither of these! You’ll only really understand why by talking to your doctor or someone in your care team. It’s useful to remember though that with some types of arthritis – for example rheumatoid arthritis – you may well need to take several different kinds of medication. Some of these will be to ease pain; others will aim to slow down the damage the disease does your joints (so your arthritis causes less swelling and inflammation in the first place).

Your doctor will be aiming to strike the right balance for you. They’ll want you to have as little pain and as much movement as possible, with no serious side effects. So changing your medication doesn’t necessarily mean your arthritis changing – it could just mean you haven’t found the mix of treatments that works best for you yet. 

It’s very unlikely that your medication will have to change because of something you have or haven’t done. It’s much more likely to be because the drug(s) aren’t working as expected in your body, or that you’re getting side-effects that are serious or hard to live with. The following questions and answers will give you more on this. It sounds obvious, but it’s really important that you fully understand and follow the instructions for taking your medicines and that you never suddenly stop taking them without speaking to your doctor first.

Again, it’s best to talk to your doctor or someone else on your care team to get an exact answer to this question. But in general terms, it can be helpful to know that there are two main groups of drugs used by people with arthritis:

• drugs that help lessen the symptoms of arthritis – such as pain, swelling and stiffness. These include are used to treat most types of arthritis including osteoarthritis and rheumatoid arthritis;
  
• drugs that stop the arthritis being so active in your joints. These include steroids and ‘disease modifying anti-rheumatic drugs’ (DMARDs for short). These drugs are only prescribed by a consultant rheumatologist.

If your doctor has changed your medicine, it could be because they feel a different drug, or a different mix of drugs, will do one of these jobs more effectively than your old medicine. On the other hand, the new medicine might be expected to work better with any other medicines you are taking, or leave you with fewer side effects if these have been a problem for you.

While a lot of people with arthritis will have absolutely no problems with their drugs, there can be side effects and some of these can be serious. You should know about these for two reasons:

• they will help you know what questions to ask your doctor when weighing up the pros and cons of trying any new drug treatment – do the bad points outweigh the good?
• you will know what signs or changes to look out for so that you can tell your doctor immediately if you think you are having any serious side effects.

While a short question and answer list like this can’t give you the depth of information you need about each drug – the Arthritis Care Drugs and complementary therapies booklet has a lot more detail. It’s easy-to-read and a good starting point if you want to understand what drugs are available and what they do.

Because arthritis can only be controlled, not cured, you’re very likely to be on some form of medication for the rest of your life. Some people with arthritis say this was a really difficult thing for them to accept at first. Worrying about possible side effects can just add to the fear and anxiety that many people have about their arthritis. That’s why feeling in control of your medication is so important. We’ve mentioned the Arthritis Care Drugs and complementary therapies booklet a lot in these answers – but it really is a great way to get to grips with all the different types of medication. Have a look also at the Coping with pain booklet in the same series. It will introduce you to some of the other non-drug treatments that people with arthritis are using (usually alongside some form of medication) including massage, hot and cold packs and exercise. If you have osteoarthritis, you might only need to take painkillers when you feel more pain or immobility than usual. Ask your doctor or pharmacist if you need some advice.

Yes. Drugs can be extremely effective in reducing pain. In some forms of arthritis certain drugs can slow down the effects of your arthritis. But just because a drug works for one person, it may not always work for you. The good news is that most people with arthritis do find a drug or combination of drugs that brings their pain and other symptoms sufficiently under control so they can get one with their lives.

Most drugs used to treat arthritis are available on the NHS – but you will still need to pay standard prescription charges unless you are entitled to help with your health costs. Unfortunately, arthritis is not one of the long-term medical conditions covered by the prescription charge exemption system in the UK. Although many people with arthritis are prescribed a range of drugs, some people find it difficult to afford them. You can buy a prescription pre-payment certificate where you pay around £100 per year up front and get unlimited prescriptions. Arthritis Care campaigns hard to ensure that everyone with arthritis can get all the treatment they need – whoever they are and wherever they happen to live. For more about getting help with your prescription charges call one the expert helpline workers at the Arthritis Care helpline on 0808 800 4050. It’s free, friendly and totally confidential.

It can be really important to take your medication at the right time. For example, non-steroidal anti-inflammatory drugs (NSAIDs for short) are the most common of all drugs used to treat arthritis. But they can cause damage to the stomach lining, so it’s safer to take them with or after meals. Some drugs you might only take once a week, or, if you have mild to moderate osteoarthritis, just when your pain or immobility is bad. Whatever drugs you have been prescribed, make sure you are absolutely clear about exactly when you need to take them. If you can’t remember what your doctor or pharmacist has told you – or if the instructions on the pack are confusing – always call back, ask and make a clear note of what they say. And even if there is some flexibility about when you take a drug, it’s a good idea to make a note of when you think it has the best effect – in the morning; just before going to sleep or any other time.

Drugs used to treat arthritis come in many forms. Painkillers (called analgesics) are usually tablets that you swallow. There are even slow-release painkilling patches (known as opioid patches) that you wear on your skin. Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed drugs for arthritis. These are usually tablets that you take by mouth, but some do come as suppositories, gels or creams. Some medications come as injections. Some – like anti-TNF drugs for inflammatory arthritis – you might need to learn to inject yourself. Others will be administered by a health professional.

Anti-TNF drugs are part of a newer group of drugs known as ‘biologics’. They are being used to reduce inflammation and control disease activity in some people with rheumatoid arthritis and other forms of inflammatory arthritis like psoriatic arthritis. The anti-TNF and biologic drugs that are already available include adalimumab, etanercept, infliximab and, more recently, rituximab. These newer drugs are proving to be very effective and are offering new hope to people with severe inflammatory arthritis. However, they are not always suitable for everyone. In fact, only around 10 per cent of people with rheumatoid arthritis would qualify for anti-TNF treatment.

Don’t be frightened to ask your doctor or care team about these medicines and whether you could benefit from them. If you want to keep up to date with the newer drugs – keep visiting the Arthritis Care website or call the Arthritis Care helpline on 0808 800 4050. This free and confidential helpline is for everyone and our friendly helpline workers will be happy to give you the latest information.

No – there are no known alternatives to the drugs used for arthritis that are scientifically proven to work. But there are a wide range of other therapies and treatments that can go with, or ‘complement’, your medication. These include herbal medicines, vitamins as well as therapies like yoga, massage, acupuncture (using needles) and hydrotherapy (where you do gentle exercise in warm water). Lots of people with arthritis find these therapies very useful for coping with pain, relaxing and generally feeling more positive and in control. The Arthritis Care booklet Drugs and complementary therapies is well worth reading. It will give you a much clearer picture of what sort of treatments are out there and what to watch out for if you decide to explore any of them further.

The drugs used to treat arthritis can be very effective but they can also be very powerful. For example, ‘disease-modifying anti-rheumatic drugs’ (DMARDs) are used to treat rheumatoid arthritis and other inflammatory forms of the disease including as lupus. They actually work by dampening down your immune system, which leaves some people more prone to infection. So naturally your doctor or care team will want to see you regularly just to ensure that the drugs are working properly and are not harming you in any way. If you are on long-term medication you should have a medication review about once a year. This may involve a chat between you and your doctor, or blood test and other checks. Remember though that you don’t have to wait to be called in for a review. If you notice any worrying changes in how you feel, you should let your doctor or care team know immediately.

There are lots of things you can do yourself to make sure you’re taking your medication safely and that you’re getting the absolute best out of it. Simply being aware of how you feel is one. Looking out for any sudden changes is really important when you are taking medication – and you need to report these to your care team straightaway. Have a look at the safety checklists in the Arthritis Care booklet Drugs and complementary therapies for more hints and tips.

And while drugs are an extremely important part of your treatment, you’re probably already realising that treating arthritis is about a lot more than just ‘taking the tablets’. There are all sorts of ways you can make a real difference to your own life – including eating the right foods and exercising. The Arthritis Care help booklets will give you loads of practical tips and advice about these. See them all at www.arthritiscare.org.uk.