The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your health care provider if you need to take any special precautions. Use each of these medications only as recommended by your health care provider, and according to the instructions provided. If you have further questions about usage or side effects, contact your health care provider.
There are a variety of medications available to treat the pain and inflammation of rheumatoid arthritis. You may have to try different medicines before you find the one that works best for you with the least number of side effects.
***Please Note: : On September 30, 2004, Merck & Co., Inc. announced a voluntary withdrawal of Vioxx(R) (rofecoxib) from the U.S. and worldwide market due to safety concerns. A recent study showed a small but significant increased risk of cardiovascular events (such as heart attack) in patients taking the prescription medication. Vioxx(R) is a so-called "selective" non-steroidal anti-inflammatory drug (NSAID) specially designed to lower the risk of stomach irritation. It is commonly used in the treatment of acute and chronic pain associated with arthritis, menstruation and other conditions. Since Merck's withdrawal of Vioxx(R), evidence has come to light regarding similar dangers posed by the other popular selective NSAID, Celebrex(R) (cefecoxib), which is produced by Pfizer. Most physicians now question the wisdom of prescribing any medications from the COX-2 class.
Although some nonsteroidal anti-inflammatory agents (NSAIDs) are available as over-the-counter medications, you may still be given a prescription in order to obtain a higher dosage. NSAIDs help decrease inflammation, swelling, and joint pain.
Be sure to take NSAIDs with food, to decrease the chance of stomach irritation.
Drinking alcoholic beverages or taking other NSAIDs or COX-2 inhibitors while you’re already using an NSAID can increase your risk of side effects.
Possible side effects include:
Stomach upset
Stomach ulcers
Kidney damage
Liver inflammation
Confusion, dizziness, lightheadedness
Severe allergic reaction (hives, difficulty breathing, swelling around the eyes)
Increased risk of bleeding – always inform your health care providers that you’re taking an NSAID before having any medical or dental procedures or surgeries
Cyclooxygenase-2 or COX-2 Inhibitors
Common names include:
Celecoxib (Celebrex)
Rofecoxib (Vioxx)
Meloxicam (Mobic)
Valdecoxib (Bextra)
COX-2 inhibitors work in a way similar to NSAIDs, helping to decrease inflammation, swelling, and joint pain. The way they do this, however, allows them to work without causing the same degree of stomach irritation. In particular, COX-2 inhibitors cause far fewer stomach ulcers than do NSAIDs.
Drinking alcoholic beverages or taking NSAIDs while you’re using a COX-2 inhibitor can increase your risk of side effects.
Possible side effects include:
Stomach upset
Liver inflammation
Confusion
Severe allergic reaction (hives, difficulty breathing, swelling around the eyes)
Disease-modifying Antirheumatic Drugs (DMARDs)
Common names include:
D-penicillamine (Cuprimine, Depen)
Hydroxychloroquine sulfate (Plaquenil)
Methotrexate (Rheumatrex)
Cyclophosphamide (Cytoxan)
Cyclosporin
These drugs are given in an effort to slow or halt the progression of rheumatoid arthritis. They are all immunosuppressive agents. Because rheumatoid arthritis is believed to be caused by an overactive immune system, it is hoped that calming the immune system’s activity will slow the progression of rheumatoid arthritis.
Immunosuppressants are used when other drugs haven’t been helpful. These medications calm the immune systems response. Unfortunately, this also means that people who take these drugs are more prone to all kinds of infections.
While you are taking these medicines, you should take very careful precautions:
Wash your hands frequently and thoroughly
For more information on washing your hands properly, click here.
Stay away from people whom you know are ill
Check with your health care provider before having any immunizations
If you notice new symptoms that might indicate an infection, contact your health care provider immediately. These include:
Fever
Chills
Difficulty breathing
Cough
Problems with urination
Pain in your side or back
Some of these medicines may also increase your risk of bleeding and/or bruising. Contact your health care provider if you have:
Black, tarry stools
Blood in your urine
Tiny, purplish-red spots on your skin
Biologic Response Modifiers
Common names include:
Etanercept (Enbrel)
– restricted in the US
Infliximab (Remicade)
These medications are given when other drugs haven’t worked. They’re both given by injection. They can help decrease the symptoms of rheumatoid arthritis. They may also increase your risk of contracting infections. You need to inform your health care provider that you are taking these medications before you get any immunizations.
Before you start taking infliximab, you’ll need a TB test to make sure you don’t have a hidden case of tuberculosis. You’ll need to have your heart monitored while you take this medicine. Contact your health care provider immediately if you develop any of the following symptoms within a few hours of your infliximab injection:
Chest pain
Difficulty breathing
Fever and chills
Itching
Hives
Flushed face
Interleukin-1 Receptor Inhibitors
Common name: anakinra (Kineret)
Interleukin-1 receptor inhibitors are usually only given to patients who have had no response to the disease-modifying antirheumatic drugs. Anakinra is given by injection under the skin.
Do not take this drug if you are also taking etanercept or infliximab. If you are breast-feeding, make sure that your health care provider knows this before you begin taking anakinra.
Possible side effects include:
Soreness and swelling at injection site
Low white blood cell count
Serious infection
Over-the-counter Medications
Acetaminophen
Common brand names include:
Actamin
Banesin
Tylenol
Acetaminophen can be helpful in relieving some of the pain associated with rheumatoid arthritis. Do not take a larger dose than is recommended by your health care provider. Do not drink alcoholic beverages while you are taking acetaminophen.
Capsaicin Cream
Common brand name: Zostrix
Capsaicin cream is rubbed on the skin of an affected joint to relieve the pain and inflammation of rheumatoid arthritis.
It’s made using the active ingredient of hot chili peppers. Some people prefer to wear rubber gloves while applying the cream. If you don’t, be sure to wash your hands very thoroughly with soap and water after using the cream. Be very careful not to get the cream near your eyes, as it will burn and sting. If you do get some in your eyes, flush them thoroughly with cool water.
Possible side effects include burning, stinging, or warm sensation when first applied to the skin.
Special Considerations
Whenever you are taking a prescription medication, take the following precautions:
Take them only as directed, not more, not less, not at a different time.
Do not stop taking them without consulting your health care provider.
Don’t share them with anyone else.
Know what effects and side effects to expect, and report them to your health care provider.
If you are taking more than one drug, even if it is over-the-counter, be sure to check with a physician or pharmacist about drug interactions.
Plan ahead for refills so you don’t run out.
Sources:
Arthritis Foundation
National Institute of Arthritis and Musculoskeletal and Skin Diseases
Cecil Textbook of Medicine, 21st ed. W.B. Saunders Company; 2000.
Conn’s Current Therapy, 54th ed. W.B. Saunders Company; 2002.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
