Appendix: Drugs used to treat arthritis

| April 1, 2008

In-Depth Report

Arthritis: Keeping Your Joints Healthy

Other types of arthritis

Physical and complementary therapies

Living with arthritis

Appendix: Drugs used to treat arthritis

Glossary

Resources

Appendix: Drugs used to treat arthritis

Mild pain relievers (analgesics)
Generic name		Brand name				Use		Side effects		Comments
acetaminophen		Panadol, Tylenol, others				Relieves pain		Nausea, vomiting, diarrhea, jaundice, rash, tiredness, weakness; less likely to cause gastric bleeding than other pain relievers		Drinking large amounts of alcohol during long-term therapy with acetaminophen may cause liver damage. Kidney damage also possible with long-term use.
aspirin		Bayer, Bufferin, others				Reduces inflammation and relieves pain		Stomach pain, bleeding, ulcers		High doses may cause ringing in the ears. Before using, let your doctor know if you are on blood thinners or have liver or kidney problems.
Oral nonsteroidal anti-inflammatory drugs (NSAIDs)
Generic name		Brand name					Use		Side effects	Comments
diclofenac		Cataflam, Voltaren					Reduce inflammation and relieve pain		Stomach pain or bleeding, ulcers, weight loss, nausea, vomiting, drowsiness, dizziness, fluid retention, heartburn, diarrhea, constipation, blurred vision, tinnitus	Allergic reactions are rare but can occur. High doses can cause ringing in the ears. People who are allergic to aspirin should not take NSAIDs. People who take high doses for a long time should have periodic blood tests to check for bleeding and liver or kidney damage. May cause kidney damage in people who are dehydrated, or who already have a kidney problem or heart failure.
diflunisal		Dolobid
etodolac		Lodine
fenoprofen		Nalfon
flurbiprofen		Ansaid
ibuprofen		Advil, Motrin, others
indomethacin		Indocin
ketoprofen		Actron, Orudis, others
meclofenamate		Meclomen
mefenamic acid		Ponstel
meloxicam		Mobic
nabumetone		Relafen
naproxen		Aleve, Naprosyn, others
oxaprozin		Daypro
phenylbutazone		Cotylbutazone
piroxicam		Feldene
sulindac		Clinoril
tolmetin		Tolectin
COX-2 inhibitor
Generic name	Brand name					Use		Side effects		Comments
celecoxib	Celebrex					Reduces inflammation and relieves pain		Stomach upset, fluid retention; fewer gastrointestinal side effects than traditional NSAIDs; possible increased risk of heart attack or stroke		Same as for NSAIDs. Does not have the beneficial cardiovascular effects of aspirin. Should not be taken by those allergic to sulfonamides (common antibiotics). Talk with your doctor if you have heart disease.
Narcotic/analgesics
Generic name	Brand name					Use		Side effects		Comments
propoxyphene	Darvon (contains aspirin), Darvocet (contains acetaminophen), others					Relieves pain		Dizziness, sedation, nausea, vomiting, constipation, abdominal pain, rash, lightheadedness, headache		May be habit-forming when taken long-term or in large doses. Should be used cautiously by people with peptic ulcers, blood-clotting disorders, and liver disease.
tramadol	Ultram					Relieves pain		Convulsions		Those with a history of seizures, psychotropic drug use, or dependence on narcotics should not take tramadol. Drug interactions are common.
Corticosteroids*
Generic name	Brand name					Use		Side effects		Comments
methylpredni-solone	Medrol					Suppresses inflammation in severe organ disease or life-threatening disease		Fluid retention, weight gain, facial hair growth, easy bruising, ulcer, loss of calcium from bones (increases risk of fractures), cataracts, acne, bacterial infection, adrenal suppression (at doses above 5 mg per day), sleeplessness, muscle wasting and weakness, headache, glucose intolerance		Side effects are related to dosage and length of therapy. If a low dose is taken for a week or less, side effects are rare. Therapy for several months or years causes more noticeable and serious side effects, even at low doses.
prednisone	Deltasone, Orasone, others					Suppresses inflammation
injectable corticosteroids	varies					Relieve pain and suppress inflammation of synovitis, bursitis, tendonitis, or carpal tunnel syndrome		Same as above; also tenderness, burning, or tingling at injection site, thinning of skin at injection site, joint infections, cartilage damage		Injected into joints, tendon sheaths, or bursae. Undesirable systemic side effects seldom occur.
*Corticosteroids suppress the adrenal glands, which produce natural steroids. Abruptly stopping oral steroids can cause a life-threatening condition called Addisonian crisis. For this reason, corticosteroids must be taken exactly as prescribed. Before stopping corticosteroids, the dosage is lowered gradually, often over a period of several weeks or months.
Disease-modifying antirheumatic drugs (DMARDs)*
Generic name			Brand name		Use			Side effects		Comments
auranofin (oral gold)			Ridaura		Reduces inflammation in rheumatoid arthritis			Diarrhea, rash, kidney problems, blood abnormalities		Less toxic, but also less effective, than injectable gold. Rarely used for rheumatoid arthritis.
azathioprine			Imuran		Suppresses immune system in lupus, rheumatoid arthritis, and psoriatic arthritis			Nausea, vomiting, diarrhea, liver damage, blood abnormalities, risk of cancer with long-term therapy, infertility		Equal to other DMARDs in effectiveness, but slightly more likely to cause side effects. Generally reserved for people who do not respond to therapy with other DMARDs. Rarely used for rheumatoid arthritis.
cyclophospha-mide			Cytoxan		Suppresses immune system in severe lupus, rheumatoid arthritis, and other rheumatic diseases			Urinary tract bleeding, risk of infection including shingles, infertility in men and women, risk of cancers (including bladder cancer and leukemia)		Generally used to treat people who are unresponsive to other therapy, or who have dangerous inflammatory conditions. This drug was originally used to treat cancer. Rarely used for rheumatoid arthritis; more commonly used to treat lupus-related kidney disease or vasculitis.
cyclosporine			Neoral		Reduces inflammation in rheumatoid arthritis			Impaired kidney function, high blood pressure, hair growth, gum swelling, tremor, convulsions, headache		This drug was originally used to prevent organ rejection in transplant patients. Its effectiveness is equal to penicillamine and azathioprine. Generally used in combination with other DMARDs.
gold salts (injectable)			Myochrysine		Reduce inflammation in rheumatoid arthritis and psoriatic arthritis			Rash, mouth ulcers; in rare cases, blood abnormalities, kidney damage, inflammation of the upper respiratory tract		Effectiveness similar to many other DMARDs. Few people stay on this therapy for longer than five years because effect wears off or side effects occur. Rarely used for rheumatoid arthritis now.
hydroxychloro-quine			Plaquenil		Suppresses inflammation in rheumatoid arthritis; reduces disease activity in lupus			Nausea, vomiting, diarrhea, irritability, nervousness, rash, visual problems		This antimalarial drug is less likely to cause side effects than chloroquine; most commonly used to treat mild rheumatoid arthritis or lupus.
leflunomide			Arava		Reduces inflammation in rheumatoid arthritis			Birth defects, liver damage		Should not be used by people with liver disease or by women who are or plan to become pregnant. Women of childbearing age should use contraception while taking leflunomide.
methotrexate			Folex, Rheumatrex, Trexall		Suppresses inflammation in rheumatoid arthritis			Nausea, abdominal pain, ulcers, appetite loss, rash, liver damage, lung damage, headaches, blurred vision, drowsiness; long-term use results in immunosuppression		Folic acid supplements reduce gastrointestinal symptoms. This drug is as effective as or slightly better than other DMARDs and works more rapidly (in one to two months) than most DMARDs.
penicillamine			Cuprimine, Depen		Suppresses inflammation in rheumatoid arthritis			Nausea, vomiting, diarrhea, rash, kidney damage, blood abnormalities, and several unusual autoimmune problems such as drug-induced lupus		Side effects are common: 25% of people stop taking the drug within the first year. Rarely used for rheumatoid arthritis or other rheumatic disease.
sulfasalazine			Azulfidine		Suppresses inflammation in rheumatoid arthritis, ankylosing spondylitis, and other spondyloarth-ropathies			Nausea, vomiting, loss of appetite, severe rash, abdominal pain, blood abnormalities, headache, low sperm count		Should not be taken by people allergic to sulfonamide antibiotics.
*While taking a DMARD, you will undergo frequent monitoring tests to avoid complications. Depending on the DMARD prescribed, such monitoring may include eye tests, blood pressure monitoring, regular urinalysis, and/or one or more blood tests (such as a complete blood count or those used to measure kidney or liver function).
Anti-TNF compounds
Generic name	Brand name				Use			Side effects		Comments
adalimumab	Humira				Suppress inflammation in rheumatoid arthritis and other rheumatic diseases such as ankylosing spondylitis			Redness and irritation at injection site, increased risk of infection; may reactivate tuberculosis; may be associated with multiple sclerosis–like reactions and, possibly, increased risk of lymphoma		Taken by self-injection. Taken every 2 weeks, with methotrexate, or on its own
etanercept	Enbrel				Same as above		Taken by self-injection once or twice weekly, often with methotrexate.
infliximab	Remicade				Same as above; may worsen heart failure		Given intravenously every 4 to 8 weeks, in conjunction with weekly oral methotrexate. Should not be used in people with heart failure.
Interleukin-1 inhibitor
Generic name	Brand name			Use				Side effects		Comments
anakinra	Kineret			Treats moderate to severe rheumatoid arthritis in people who do not respond to DMARD drugs				Mild redness and swelling at site of injection, headache, nausea, diarrhea		Taken by injection. Should not be used in combination with TNF-blocking agents.
Immune cell inhibitors
Abatacept	Orencia			Suppresses inflammation, for moderate to severe rheumatoid arthritis in people who do not respond to DMARD drugs				Headache, sore throat, nausea; rare but serious allergic reactions, increased risk of infection and possibly cancer. May worsen symptoms of chronic obstructive pulmonary disease (COPD)		Taken by monthly intravenous injection. Should not be used in combination with TNF-blocking agents
Rituximab	Rituxan			In combination with methotrexate, suppresses inflammation, for moderate to severe rheumatoid arthritis in people who do not respond to anti-TNF compounds				Infusion reactions; fever, chills, shakes, itching, hives, sneezing, swelling, throat irritation or tightness, and cough within 1-2 days after injection; increased risk of infection		Taken by intravenous injection twice over 2 weeks, often repeated every 6 to 12 months. Should not be used in combination with TNF-blocking agents.