Medication RA

Medications used for Rheumatoid Arthritis (RA)

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Please note – this information is taken from Versus Arthritis, and the British National Formulary.  By clicking on the blue highlighted drug names, you will be taken to the Versus Arthritis website for further information.

 

 

 

 

There are four main groups of medications that are used to help treat rheumatoid arthritis. These are:

  • painkillers
  • non-steroidal anti-inflammatory drugs (NSAIDs)
  • disease-modifyng anti-rheumatic drugs (DMARDs)
  • steroids (also known as corticosteroids).

Many people with rheumatoid arthritis need to take more than one medication.  This is because different medications work in different ways.

 

Your medication treatments may be changed from time to time. This can depend on how bad your symptoms are, or because something relating to your condition has changed.  Your specialist will work with you to decide which treatments and medications may suit you best.  The majority of these medications can only be started by a rheumatology specialist, but your GP will support any ongoing prescriptions and monitoring, once you are settled on a regime.

 

Medications may be available under several different names, which can be confusing. Each drug has an approved name – sometimes called a generic name.  Manufacturers often give their own brand or trade name to the drug as well. For example, Nurofen is a brand name for ibuprofen.  The approved name should always be on the pharmacist’s label, even if a brand name appears on the packaging. Check with your doctor, rheumatology nurse specialist or pharmacist if you’re not sure about anything.

 

For further information on painkillers and anti-inflammatories, click on this link – analgesia

DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS (DMARDS)

 

There are three types of DMARD:

– conventional synthetic DMARDs (sometimes called csDMARDs)

– biological therapies (sometimes called bDMARDs).

– targeted synthetic DMARDs (sometimes called tsDMARDS).

As well as considering your RA , medical history, current medications, lifestyle and preference will effect which medications may suit you best.  Some medications require regular bloods tests, where others not so much.  Some people may struggle with taking tablets, so medications that are available in liquid or injection form may be more appropriate.  All options will be discussed with you , so a joint decision can be made between yourself and your specialist.

 

Many medications used to manage RA may take a few months to take effect, excluding steroids and most painkillers/anti-inflammatory’s.  It is important to keep taking your medication during this time.  If you do have any problems with the medication, such as undesired side effects, or have questions about how to take the medication, either discuss these with your pharmacist or contact your rheumatology team.

 

The table below shows the DMARDs available for the treatment of rheumatoid arthritis.  If you click on the drug name, you will be taken to the Versus Arthritis website, where many questions can be answered with the information you will find there.

 

Name Type of DMARD & frequency
Azathioprine tablets Conventional synthetic DMARD

Daily tablets

Hydroxychloroquine tablets Conventional synthetic DMARD

Daily tablets

Leflunomide tablets Conventional synthetic DMARD

Daily tablets

Methotrexate tablets or injections Conventional synthetic DMARD

Weekly tablets/injection

Sulfasalazine tablets or suspension Conventional synthetic DMARD

Daily tablets

Etanercept injections Biologic; Anti-TNF

Once or twice weekly injections

Infliximab infusions Biologic; Anti-TNF

Infusions every 4-8 weeks, dependent on response

Rituximab infusions Biologic; Anti lymphocyte monoclonal antibody

Infusions at minimum of 6 month intervals

Baricitinib tablets

 

Filgotanib tablets

Targeted synthetic DMARD (JAK inhibitor)

Daily tablet

Targeted synthetic DMARD (JAK inhibitor)

Daily tablet

Tofacitinib tablets

 

Upadacitinib tablets

Targeted synthetic DMARD (JAK inhibitor)

Daily tablets

Targeted synthetic DMARD (JAK inhibitor)

Daily tablets

Sarilumab injections Biologic: Anti IL6

Injection every 2 weeks

Certolizumab pegol injections Biologic; Anti-TNF

Injections every 2 weeks

Adalimumab injections Biologic; Anti-TNF

Injection every 2 weeks

Golimumab injections Biologic; Anti-TNF

Injections once a month

Abatacept injections or infusion Biologic T cell co-stimulator

Injections once weekly

Infusions fortnightly for 3 doses, then monthly

Tocilizumab injections or infusion Biologic; Anti IL6

Injections once weekly

Infusions every 4 weeks

 

STEROIDS

Steroids are sometimes known by their full name: corticosteroids.  Corticosteroids help to reduce the pain, stiffness and inflammation caused by rheumatoid arthritis.  The most commonly used is Prednisolone.

They can be used as:

  • a tablet
  • an injection directly into a painful joint
  • an injection into your muscle.

 

They’re usually used to provide immediate short-term pain relief. This could be during a flare-up or while you’re waiting for your DMARD medication to start working.  Corticosteroids are normally only used in this way because long-term use of corticosteroids can have serious side effects, including weight gain, osteoporosis, eye problems and thinning of the skin to name a few.

 

You shouldn’t stop taking your steroid tablets or alter the dose unless advised to by your doctor. It can be dangerous to stop steroids suddenly.

 

NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS)

 

NSAIDs can be used to help control symptoms of pain, swelling or stiffness. They can be used in combination with painkillers.  NSAIDs start working within a few hours, with the effects felt for a few hours to a whole day.  Ibuprofen is a commonly prescribed NSAID.

NSAIDs can be taken as a:

    • tablet
  • capsule
  • liquid
  • suppository to be inserted into your bottom
  • cream or gel
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