Drugs are the basis of the treatment plan for RA. A series of protocols designed by the American College of Rheumatology, ACR, direct the treatment of rheumatoid arthritis in the American community. Information regarding these protocols can be found on their webpage. American College of Rheumatology.

• DMARDs, Disease Modifying Anti-Rheumatic Drugs are a category of drugs that reduce the symptoms of RA and slow the progression of the disease. These drugs can not cure RA, but they can make a patient feel better and they can delay permanent damage caused by the disease. This category of drugs includes:
  • the traditional chemical drugs, like methotrexate
  • biologics, like Orencia and Humira
  • Janus Kinase inhibitors, the JAK inhibitors, like Xeljanz, Tofacitinib                                                                                                           
  • the biosimilars, Amjevita (adalimumab-atto)  is a biosimilar of Humira 

• NSAIDs, Non-Steroidal Anti-Inflammatory Drugs, are a class of drugs that reduce the inflammation of RA. These drugs relieve some of the symptoms of RA, but they do not change the course of the disease.  Examples are :
  • Aspirin
  • ibuprofen
  • naproxen
  • Voltarin ointment
  • prescription NSAIDs such as Mobic, Voltarin and Celebrex.

Over the counter drugs (OTC) are sometimes over-used because people think that since they are OTC, they must be safe. They are safe only if their cautions are respected. Aspirin and ibuprofen can be dangerous drugs.

• Steroids, like prednisone and methylprednisolone, are powerful drugs that relieve symptoms of RA. They are used to calm the symptoms of a flare. They are used as bridge therapy., calming symptoms until the DMARD starts working. They are also used to help control symptoms of severe disease.

• Analgesics start with ibuprofen and naproxen as noted under NSAIDs.  Tramadol is a weak opiate that is frequently used for RA. Norco and Lortab are combinations of acetaminophen/hydrocodone. Acetaminophen  is not very effective when used alone for RA, but it boosts the pain relief when used with hydrocodone. Remember about a third of those with RA do not respond to RA drugs.

There was a time not far in the past when doctors started RA treatment with a NSAID like ibuprofen. DMARDs were not started until joint damage was noted.

Although NSAIDs can reduce inflammation, they will not slow the progression of the disease.

Today RA patients are started on a DMARD usually methotrexate.  Those with a milder disease might be started on hydroxychloroquine, Plaquenil. After a few months, a combination therapy might be tried. After a few months if there is no improvement, a TNF inhibitor, a biologic, might be started.

Most of the drugs for RA depress the immune system and will increase the risk of infection.

This is the first in a series of articles about treatment for RA. Next will be an in-depth report on the first line of treatment the traditional chemical drugs like methotrexate and Plaquenil.

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