There are many different drugs used in the treatment of rheumatoid arthritis. Some are used primarily to ease the symptoms of RA; others are used to slow or stop the course of the disease and to inhibit structural damage. Most of these drugs fall into one of the following categories:
NSAIDs: Nonsteroidal anti-inflammatory drugs include more than a dozen different medications – some available over-the-counter, some available by prescription only – used to help ease arthritis pain and inflammation. NSAIDs include such drugs as ibuprofen (Advil, Motrin), ketoprofen (Actron, Orudis KT) and naproxen sodium (Aleve), among others. If you have had or are at risk of stomach ulcers, your doctor may prescribe celecoxib (Celebrex), a type of NSAID called a COX-2 inhibitor, which is designed to be safer for the stomach.
Corticosteroids – Corticosteroid medications, including prednisone, prednisolone and methyprednisolone, are potent and quick-acting anti-inflammatory medications. They may be used in RA to get potentially damaging inflammation under control, while waiting for NSAIDs and DMARDs (below) take effect. Because of the risk of side effects with these drugs, doctors prefer to use them for as short a time as possible and in doses as low as possible.
DMARDs: An acronym for disease-modifying antirheumatic drugs, DMARDs are drugs that work slowly to actually modify the course of the disease. In recent years, the most commonly used DMARD for rheumatoid arthritis is methotrexate. But there are about a dozen others that fall into this category. They include hydroxycholorquine (Plaquenil), sulfasalazine (Azulfidine, Azulfidine EN-Tabs), leflunomide (Arava) and azathioprine (Imuran).
A person diagnosed with rheumatoid arthritis today is likely to be prescribed a DMARD fairly early in the course of their disease, as doctors have found that starting these drugs early on can help prevent irreparable joint damage that might occur if their use was delayed.
Biologic agents: The newest category of medications used for rheumatoid arthritis is a subset of DMARDs called biologic response modifiers, or biologics. There are currently nine such agents approved for rheumatoid arthritis: abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), certolizumab pegol (Cimzia) etanercept (Enbrel), infliximab (Remicade), golimumab (Simponi) and rituximab (Rituxan).
Each of the biologics blocks a specific step in the inflammation process. Cimzia, Enbrel, Humira, Remicade and Simponi block a cytokine called tumor necrosis factor-alpha (TNF), and therefore often are called TNF inhibitors. Kineret blocks a cytokine called interleukin-1 (IL-1). Orencia blocks the activation of T cells. Rituxan blocks B cells. Actemra blocks a cytokine called interleukin-6 (IL-6).
Because these agents target specific steps in the process, they don’t wipe out the entire immune response as some other RA treatments do, and in many people a biologic agent can slow, modify or stop the disease – even when other treatments haven’t helped much.
JAK inhibitors: A new drug, tofacitinib (Xeljanz) is being compared to biologics. However, it is part of a new subcategory of DMARDs known as “JAK inhibitors” that block Janus kinase, or JAK, pathways, which are involved in the body’s immune response. Unlike biologics, it can be taken orally.